50D2263838 CLIA NUMBER - EVERGREEN GENTLE SENIOR CARE LLC

Laboratory Demographics

  • CLIA Code: 50D2263838
  • Facility Name: EVERGREEN GENTLE SENIOR CARE LLC
  • Facility Address: 12516 NE 147TH PL
    WOODINVILLE, WA
    ZIP 98072
  • Facility Phone: 206 354-4904
  • Facility Type: Other - AFH
  • Facility Type: Waiver
  • Lab Director: IONA SURUGITE
  • NPI Number: 1942301122
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D2263838
LAB Type Other - AFH
Facility Name EVERGREEN GENTLE SENIOR CARE LLC
Street 12516 NE 147TH PL
City WOODINVILLE
State WA
ZIP 98072
Phone 206 354-4904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2022
Certificate Expiration Date 4/4/2028
Facility Type Other - AFH
Lab Director IONA SURUGITE

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