01D2176357 CLIA NUMBER - MONTGOMERY COUNTY YOUTH FACILITY

Laboratory Demographics

  • CLIA Code: 01D2176357
  • Facility Name: MONTGOMERY COUNTY YOUTH FACILITY
  • Facility Address: 1111 AIR BASE BLVD
    MONTGOMERY, AL
    ZIP 36108
  • Facility Phone: 205 437-1512
  • Facility Type: Other - COUNTY JAIL
  • Facility Type: Waiver
  • Lab Director: DR. VANOSIA FAISON
  • NPI Number: 1396785143
  • Taxonomy: 3336S0011X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2176357
LAB Type Other - COUNTY JAIL
Facility Name MONTGOMERY COUNTY YOUTH FACILITY
Street 1111 AIR BASE BLVD
City MONTGOMERY
State AL
ZIP 36108
Phone 205 437-1512
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2023
Certificate Expiration Date 12/11/2025
Facility Type Other - COUNTY JAIL
Lab Director DR. VANOSIA FAISON

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