39D2069347 CLIA NUMBER - PROVIDENCE SQUARE HOME TRAINING

Laboratory Demographics

  • CLIA Code: 39D2069347
  • Facility Name: PROVIDENCE SQUARE HOME TRAINING
  • Facility Address: 2835 W CHESTER PIKE, STE#2
    BROOMALL, PA
    ZIP 19008
  • Facility Phone: (610) 356-2719
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. FAZLE A. NOOR
  • NPI Number: 1417389321
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2069347
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PROVIDENCE SQUARE HOME TRAINING
Street 2835 W CHESTER PIKE, STE#2
City BROOMALL
State PA
ZIP 19008
Phone 6103562719
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2025
Certificate Expiration Date 11/21/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. FAZLE A. NOOR

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This page was last updated on: 5/18/2026