53D2145487 CLIA NUMBER - CROSSROADS HEALTH LLC

Laboratory Demographics

CLIA Number: 53D2145487

Facility Name: CROSSROADS HEALTH LLC

Facility Address:
1156 NORTH MAIN STREET
SHERIDAN, WY
ZIP 82801
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Facility Phone Number: 307 751-0645

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730636812

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	53D2145487
LAB Type	Physician Office
Facility Name	CROSSROADS HEALTH LLC
Street	1156 NORTH MAIN STREET
City	SHERIDAN
State	WY
ZIP	82801
Phone	307 751-0645
CertificateType	4
CertificateEffectiveDate	3/8/2024
CertificateExpirationDate	3/7/2026
FacilityType	Waiver

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