07D2057181 CLIA NUMBER - PROJECT COURAGE

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Laboratory Demographics

CLIA Number: 07D2057181

Facility Name: PROJECT COURAGE

Facility Address:
130 ELM ST
OLD SAYBROOK, CT
ZIP 06475
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Facility Phone Number: 860 388-9656

Facility Type: Other - OUTPT ADDIC & MENTAL HEAL

Certificate Type: Waiver

NPI Number: 1659716405

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D2057181
LAB Type	Other - OUTPT ADDIC & MENTAL HEAL
Facility Name	PROJECT COURAGE
Street	130 ELM ST
City	OLD SAYBROOK
State	CT
ZIP	06475
Phone	860 388-9656
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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