Provider Demographics
NPI:1003562943
Name:CLECORE LAB & SCREENINGS LLC
Entity Type:Organization
Organization Name:CLECORE LAB & SCREENINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PN161964
Authorized Official - Phone:216-324-2161
Mailing Address - Street 1:3247 E OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2143
Mailing Address - Country:US
Mailing Address - Phone:216-324-2161
Mailing Address - Fax:
Practice Address - Street 1:3247 E OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2143
Practice Address - Country:US
Practice Address - Phone:216-324-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291900000XLaboratoriesMilitary Clinical Medical Laboratory
No291U00000XLaboratoriesClinical Medical Laboratory