39D2012045 CLIA NUMBER - FAIRMOUNT PRIM CR CTR AT HORIZON HOUSE

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Laboratory Demographics

CLIA Number: 39D2012045

Facility Name: FAIRMOUNT PRIM CR CTR AT HORIZON HOUSE

Facility Address:
5901 MARKET STREET, 2ND FLOOR
PHILADELPHIA, PA
ZIP 19139
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Facility Phone Number: 215 235-9600

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1811202153

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2012045
LAB Type	Federally Qualified Health Center
Facility Name	FAIRMOUNT PRIM CR CTR AT HORIZON HOUSE
Street	5901 MARKET STREET, 2ND FLOOR
City	PHILADELPHIA
State	PA
ZIP	19139
Phone	215 235-9600
CertificateType	4
CertificateEffectiveDate	8/27/2022
CertificateExpirationDate	8/26/2024
FacilityType	Waiver

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