47D2205145 CLIA NUMBER - NORTHEAST KINGDOM HUMAN SERVICES INC

Laboratory Demographics

  • CLIA Code: 47D2205145
  • Facility Name: NORTHEAST KINGDOM HUMAN SERVICES INC
  • Facility Address: 181 CRAWFORD ROAD
    DERBY, VT
    ZIP 05829
  • Facility Phone: (802) 748-6350
  • Facility Type: Other - RCH
  • Facility Type: Waiver
  • Lab Director: PETER M. KOSTRUBA
  • NPI Number: 1215811922
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 47D2205145
LAB Type Other - RCH
Facility Name NORTHEAST KINGDOM HUMAN SERVICES INC
Street 181 CRAWFORD ROAD
City DERBY
State VT
ZIP 05829
Phone 8027486350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Other - RCH
Lab Director PETER M. KOSTRUBA

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This page was last updated on: 5/18/2026