02D2276977 CLIA NUMBER - BANYAN ALASKA LLC

Laboratory Demographics

CLIA Number: 02D2276977

Facility Name: BANYAN ALASKA LLC

Facility Address:
4750 E BEGICH CIRCLE
WASILLA, AK
ZIP 99654
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Facility Phone Number: 954 533-7705

Facility Type: Other - SUBSTANCE ABUSE TREATMENT

Certificate Type: Waiver

NPI Number: 1902518848

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	02D2276977
LAB Type	Other - SUBSTANCE ABUSE TREATMENT
Facility Name	BANYAN ALASKA LLC
Street	4750 E BEGICH CIRCLE
City	WASILLA
State	AK
ZIP	99654
Phone	954 533-7705
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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