41D2215560 CLIA NUMBER - RENAISSANCE ADHC

Laboratory Demographics

  • CLIA Code: 41D2215560
  • Facility Name: RENAISSANCE ADHC
  • Facility Address: 1090 EDDY ST
    PROVIDENCE, RI
    ZIP 02905
  • Facility Phone: 401 461-8000
  • Facility Type: Other - ADULT DAY HLTH CNTR
  • Facility Type: Waiver
  • Lab Director: KRYSTAL M. SICAL
  • NPI Number: 1831590355
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 41D2215560
LAB Type Other - ADULT DAY HLTH CNTR
Facility Name RENAISSANCE ADHC
Street 1090 EDDY ST
City PROVIDENCE
State RI
ZIP 02905
Phone 401 461-8000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Other - ADULT DAY HLTH CNTR
Lab Director KRYSTAL M. SICAL

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