49D1069901 CLIA NUMBER - GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 49D1069901

Facility Name: GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER

Facility Address:
3350 COMMISSION COURT
WOODBRIDGE, VA
ZIP 22192
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Facility Phone Number: 703 680-7950

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1942527874

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D1069901
LAB Type	Community Clinic
Facility Name	GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
Street	3350 COMMISSION COURT
City	WOODBRIDGE
State	VA
ZIP	22192
Phone	703 680-7950
CertificateType	4
CertificateEffectiveDate	6/15/2023
CertificateExpirationDate	6/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024