50D2332797 CLIA NUMBER - PACIFIC BREEZE AFH LLC

Laboratory Demographics

  • CLIA Code: 50D2332797
  • Facility Name: PACIFIC BREEZE AFH LLC
  • Facility Address: 16017 NE 79TH WAY
    VANCOUVER, WA
    ZIP 98682
  • Facility Phone: (360) 605-8930
  • Facility Type: Other - AFH
  • Facility Type: Waiver
  • Lab Director: HABTE M. SIMON
  • NPI Number: 1043157324
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 50D2332797
LAB Type Other - AFH
Facility Name PACIFIC BREEZE AFH LLC
Street 16017 NE 79TH WAY
City VANCOUVER
State WA
ZIP 98682
Phone 3606058930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2025
Certificate Expiration Date 4/4/2028
Facility Type Other - AFH
Lab Director HABTE M. SIMON

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This page was last updated on: 5/18/2026