51D0979141 CLIA NUMBER - FAMILY HEALTHCARE ASSOC INC

Laboratory Demographics

CLIA Number: 51D0979141

Facility Name: FAMILY HEALTHCARE ASSOC INC

Facility Address:
114 MAIN STREET
MAN, WV
ZIP 25635
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Facility Phone Number: 304 583-0020

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902835010

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	51D0979141
LAB Type	Physician Office
Facility Name	FAMILY HEALTHCARE ASSOC INC
Street	114 MAIN STREET
City	MAN
State	WV
ZIP	25635
Phone	304 583-0020
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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