39D2293119 CLIA NUMBER - FELLOWSHIP HOUSE

Laboratory Demographics

  • CLIA Code: 39D2293119
  • Facility Name: FELLOWSHIP HOUSE
  • Facility Address: 126 WILLOW AVE
    OLYPHANT, PA
    ZIP 18447
  • Facility Phone: 570 382-8157
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW C. HALEY
  • NPI Number: 1770208571
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2293119
LAB Type Community Clinic
Facility Name FELLOWSHIP HOUSE
Street 126 WILLOW AVE
City OLYPHANT
State PA
ZIP 18447
Phone 570 382-8157
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Community Clinic
Lab Director DR. MATTHEW C. HALEY

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This page was last updated on: 9/29/2025