39D2293372 CLIA NUMBER - PROVIDENCE TREATMENT

Laboratory Demographics

  • CLIA Code: 39D2293372
  • Facility Name: PROVIDENCE TREATMENT
  • Facility Address: 1528 WALNUT STREET, SUITE 1410
    PHILADELPHIA, PA
    ZIP 19102
  • Facility Phone: 312 342-5304
  • Facility Type: Other - OUTPATIENT CARE
  • Facility Type: Waiver
  • Lab Director: DR. DAVID STEINMAN
  • NPI Number: 1962965145
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2293372
LAB Type Other - OUTPATIENT CARE
Facility Name PROVIDENCE TREATMENT
Street 1528 WALNUT STREET, SUITE 1410
City PHILADELPHIA
State PA
ZIP 19102
Phone 312 342-5304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Other - OUTPATIENT CARE
Lab Director DR. DAVID STEINMAN

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