46D2115872 CLIA NUMBER - RENAISSANCE RANCH OUTPATIENT OF LOGAN

Laboratory Demographics

  • CLIA Code: 46D2115872
  • Facility Name: RENAISSANCE RANCH OUTPATIENT OF LOGAN
  • Facility Address: 664 N MAIN ST #201
    LOGAN, UT
    ZIP 84321
  • Facility Phone: 435 213-9036
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: NICK R. LINDHOLM
  • NPI Number: 1881055861
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2115872
LAB Type Comp. Outpatient Rehab Facility
Facility Name RENAISSANCE RANCH OUTPATIENT OF LOGAN
Street 664 N MAIN ST #201
City LOGAN
State UT
ZIP 84321
Phone 435 213-9036
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director NICK R. LINDHOLM

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