39D2116989 CLIA NUMBER - GPHA SOUTHEAST HEALTH CENTER

Laboratory Demographics

CLIA Number: 39D2116989

Facility Name: GPHA SOUTHEAST HEALTH CENTER

Facility Address:
800 WASHINGTON AVENUE
PHILADELPHIA, PA
ZIP 19147
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Facility Phone Number: 215 339-5100

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1417902362

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2116989
LAB Type	Federally Qualified Health Center
Facility Name	GPHA SOUTHEAST HEALTH CENTER
Street	800 WASHINGTON AVENUE
City	PHILADELPHIA
State	PA
ZIP	19147
Phone	215 339-5100
CertificateType	3
CertificateEffectiveDate	8/8/2022
CertificateExpirationDate	8/7/2024
FacilityType	PPMP

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