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39D2002622 CLIA NUMBER - LIFE ST MARY

Laboratory Demographics

CLIA Number: 39D2002622

Facility Name: LIFE ST MARY

Facility Address:
2500 NORTHGATE ROAD
TREVOSE, PA
ZIP 19053
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Facility Phone Number: 267 991-7601

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1003052820

Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.

CLIA Record

Field Name Field Value
CLIA Number 39D2002622
LAB Type Physician Office
Facility Name LIFE ST MARY
Street 2500 NORTHGATE ROAD
City TREVOSE
State PA
ZIP 19053
Phone 267 991-7601
CertificateType 4
CertificateEffectiveDate 1/22/2024
CertificateExpirationDate 1/21/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024