06D2137671 CLIA NUMBER - DIVERSUS HEALTH SERVICES

Laboratory Demographics

CLIA Number: 06D2137671

Facility Name: DIVERSUS HEALTH SERVICES

Facility Address:
1795 JET WING DRIVE
COLORADO SPRINGS, CO
ZIP 80916
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Facility Phone Number: 719 572-6100

Facility Type: Other - COMM MENTAL HEALTH

Certificate Type: Waiver

NPI Number: 1861036725

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2137671
LAB Type	Other - COMM MENTAL HEALTH
Facility Name	DIVERSUS HEALTH SERVICES
Street	1795 JET WING DRIVE
City	COLORADO SPRINGS
State	CO
ZIP	80916
Phone	719 572-6100
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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