01D2153365 CLIA NUMBER - DBA BHG CULLMAN TREATMENT CENTER TTC, LLC

Laboratory Demographics

CLIA Number: 01D2153365

Facility Name: DBA BHG CULLMAN TREATMENT CENTER TTC, LLC

Facility Address:
1912 COMMERCE AVE NW
CULLMAN, AL
ZIP 35055
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Facility Phone Number: 256 739-5595

Facility Type: Other - OUTPT OPIOID TREATMENT

Certificate Type: Waiver

NPI Number: 1023591039

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2153365
LAB Type	Other - OUTPT OPIOID TREATMENT
Facility Name	DBA BHG CULLMAN TREATMENT CENTER TTC, LLC
Street	1912 COMMERCE AVE NW
City	CULLMAN
State	AL
ZIP	35055
Phone	256 739-5595
CertificateType	4
CertificateEffectiveDate	8/24/2022
CertificateExpirationDate	8/23/2024
FacilityType	Waiver

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