41D2129480 CLIA NUMBER - DISCOVERY HOUSE - PROVIDENCE

Laboratory Demographics

  • CLIA Code: 41D2129480
  • Facility Name: DISCOVERY HOUSE - PROVIDENCE
  • Facility Address: 66 PAVILION AVE
    PROVIDENCE, RI
    ZIP 02905
  • Facility Phone: 401 461-9110
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: LISA PONTARELLI
  • NPI Number: 1306845185
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 41D2129480
LAB Type Comp. Outpatient Rehab Facility
Facility Name DISCOVERY HOUSE - PROVIDENCE
Street 66 PAVILION AVE
City PROVIDENCE
State RI
ZIP 02905
Phone 401 461-9110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director LISA PONTARELLI

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