41D2302940 CLIA NUMBER - BHG LXXIX, LLC D/B/A BHG MEDICAL SERVICES - RHODE ISLAND

Laboratory Demographics

  • CLIA Code: 41D2302940
  • Facility Name: BHG LXXIX, LLC D/B/A BHG MEDICAL SERVICES - RHODE ISLAND
  • Facility Address: 82 POND ST, OBOT ROOM #100
    PAWTUCKET, RI
    ZIP 02860
  • Facility Phone: 401 727-1287
  • Facility Type: Other - OFFICE BASED OPIOID TREAT
  • Facility Type: Waiver
  • Lab Director: RANDY RAUSO
  • NPI Number: 1902516917
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 41D2302940
LAB Type Other - OFFICE BASED OPIOID TREAT
Facility Name BHG LXXIX, LLC D/B/A BHG MEDICAL SERVICES - RHODE ISLAND
Street 82 POND ST, OBOT ROOM #100
City PAWTUCKET
State RI
ZIP 02860
Phone 401 727-1287
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Other - OFFICE BASED OPIOID TREAT
Lab Director RANDY RAUSO

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