53D2245762 CLIA NUMBER - HAVEN DIRECT HEALTH SYSTEMS, LLC

Laboratory Demographics

  • CLIA Code: 53D2245762
  • Facility Name: HAVEN DIRECT HEALTH SYSTEMS, LLC
  • Facility Address: 716 COLLEGE VIEW DR
    RIVERTON, WY
    ZIP 82501
  • Facility Phone: 307 463-0113
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JADELL HOVANDER
  • NPI Number: 1043977176
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D2245762
LAB Type Physician Office
Facility Name HAVEN DIRECT HEALTH SYSTEMS, LLC
Street 716 COLLEGE VIEW DR
City RIVERTON
State WY
ZIP 82501
Phone 307 463-0113
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Physician Office
Lab Director JADELL HOVANDER

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