50D0698378 CLIA NUMBER - PROVIDENCE HOME SERVICES

Laboratory Demographics

CLIA Number: 50D0698378

Facility Name: PROVIDENCE HOME SERVICES

Facility Address:
2811 S 102ND ST STE 220
TUKWILA, WA
ZIP 98168
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Facility Phone Number: 425 391-2848

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1689827321

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	50D0698378
LAB Type	Other
Facility Name	PROVIDENCE HOME SERVICES
Street	2811 S 102ND ST STE 220
City	TUKWILA
State	WA
ZIP	98168
Phone	425 391-2848
CertificateType	4
CertificateEffectiveDate	7/31/2000
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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