02D2112179 CLIA NUMBER - COMMUNITY MEDICAL SERVICES

Laboratory Demographics

CLIA Number: 02D2112179

Facility Name: COMMUNITY MEDICAL SERVICES

Facility Address:
2521 E MOUNTAIN VILLAGE DR, STE F
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 290-3760

Facility Type: Other - OUTPATIENT TREATMENT PROG

Certificate Type: Waiver

NPI Number: 1659722114

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	02D2112179
LAB Type	Other - OUTPATIENT TREATMENT PROG
Facility Name	COMMUNITY MEDICAL SERVICES
Street	2521 E MOUNTAIN VILLAGE DR, STE F
City	WASILLA
State	AK
ZIP	99654
Phone	907 290-3760
CertificateType	4
CertificateEffectiveDate	4/25/2024
CertificateExpirationDate	4/24/2026
FacilityType	Waiver

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