10D0952130 CLIA NUMBER - SUNCOAST NEW OPTIONS SPRING STREET, LLC

Laboratory Demographics

CLIA Number: 10D0952130

Facility Name: SUNCOAST NEW OPTIONS SPRING STREET, LLC

Facility Address:
930 S W SPRING LANE
LAKE CITY, FL
ZIP 32025
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Facility Phone Number: 352 372-0130

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1457786386

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	10D0952130
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SUNCOAST NEW OPTIONS SPRING STREET, LLC
Street	930 S W SPRING LANE
City	LAKE CITY
State	FL
ZIP	32025
Phone	352 372-0130
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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