50D2197816 CLIA NUMBER - LIGHTHOUSE INFUSIONS & SEATTLE KETAMINE

Laboratory Demographics

  • CLIA Code: 50D2197816
  • Facility Name: LIGHTHOUSE INFUSIONS & SEATTLE KETAMINE
  • Facility Address: 5701 NE BOTHELL WAY STE 4
    KENMORE, WA
    ZIP 98028
  • Facility Phone: 425 835-2363
  • Facility Type: Other - INFUSION CLINIC
  • Facility Type: Waiver
  • Lab Director: LIANA REN
  • NPI Number: 1043037120
  • Taxonomy: 261QI0500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D2197816
LAB Type Other - INFUSION CLINIC
Facility Name LIGHTHOUSE INFUSIONS & SEATTLE KETAMINE
Street 5701 NE BOTHELL WAY STE 4
City KENMORE
State WA
ZIP 98028
Phone 425 835-2363
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2020
Certificate Expiration Date 4/4/2028
Facility Type Other - INFUSION CLINIC
Lab Director LIANA REN

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