50D2237506 CLIA NUMBER - EDUCATIONAL SERVICE DISTRICT 112

Laboratory Demographics

CLIA Number: 50D2237506

Facility Name: EDUCATIONAL SERVICE DISTRICT 112

Facility Address:
2500 NE 65TH AVE
VANCOUVER, WA
ZIP 98661
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Facility Phone Number: 360 750-7500

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1790008928

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	50D2237506
LAB Type	School/Student Health Service
Facility Name	EDUCATIONAL SERVICE DISTRICT 112
Street	2500 NE 65TH AVE
City	VANCOUVER
State	WA
ZIP	98661
Phone	360 750-7500
CertificateType	4
CertificateEffectiveDate	9/24/2021
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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