46D0525159 CLIA NUMBER - INTERMOUNTAIN HEALTH HOME HEALTH - OGDEN

Laboratory Demographics

  • CLIA Code: 46D0525159
  • Facility Name: INTERMOUNTAIN HEALTH HOME HEALTH - OGDEN
  • Facility Address: 3776 WALL AVENUE
    OGDEN, UT
    ZIP 84405
  • Facility Phone: 801 399-1400
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: DOMINIC MOORE
  • NPI Number: 1477540870
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 46D0525159
LAB Type Home Health Agency
Facility Name INTERMOUNTAIN HEALTH HOME HEALTH - OGDEN
Street 3776 WALL AVENUE
City OGDEN
State UT
ZIP 84405
Phone 801 399-1400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Home Health Agency
Lab Director DOMINIC MOORE

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