02D2177251 CLIA NUMBER - ALASKA TREATMENT CENTER

Laboratory Demographics

CLIA Number: 02D2177251

Facility Name: ALASKA TREATMENT CENTER

Facility Address:
1577 C STREET, STE 204
ANCHORAGE, AK
ZIP 99501
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Facility Phone Number: 907 538-9958

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1104464460

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	02D2177251
LAB Type	Practitioner Other
Facility Name	ALASKA TREATMENT CENTER
Street	1577 C STREET, STE 204
City	ANCHORAGE
State	AK
ZIP	99501
Phone	907 538-9958
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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