06D2150442 CLIA NUMBER - SAN LUIS VALLEY BEHAVIORAL HEALTH GROUP

Laboratory Demographics

CLIA Number: 06D2150442

Facility Name: SAN LUIS VALLEY BEHAVIORAL HEALTH GROUP

Facility Address:
8745 COUNTY ROAD 9 SOUTH
ALAMOSA, CO
ZIP 81101
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Facility Phone Number: 719 589-3671

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1053937391

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2150442
LAB Type	Practitioner Other
Facility Name	SAN LUIS VALLEY BEHAVIORAL HEALTH GROUP
Street	8745 COUNTY ROAD 9 SOUTH
City	ALAMOSA
State	CO
ZIP	81101
Phone	719 589-3671
CertificateType	4
CertificateEffectiveDate	6/25/2022
CertificateExpirationDate	6/24/2024
FacilityType	Waiver

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