07D2020959 CLIA NUMBER - MC1 HEALTHCARE D/B/A- MOUNTAINSIDE TREATMENT CENTER

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Laboratory Demographics

CLIA Number: 07D2020959

Facility Name: MC1 HEALTHCARE D/B/A- MOUNTAINSIDE TREATMENT CENTER

Facility Address:
187 S CANAAN ROAD
CANAAN, CT
ZIP 06018
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Facility Phone Number: 860 824-1397

Facility Type: Other - SUBSTANCE ABUSE TRT CTR

Certificate Type: Waiver

NPI Number: 1255710422

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	07D2020959
LAB Type	Other - SUBSTANCE ABUSE TRT CTR
Facility Name	MC1 HEALTHCARE D/B/A- MOUNTAINSIDE TREATMENT CENTER
Street	187 S CANAAN ROAD
City	CANAAN
State	CT
ZIP	06018
Phone	860 824-1397
CertificateType	4
CertificateEffectiveDate	3/25/2024
CertificateExpirationDate	3/24/2026
FacilityType	Waiver

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