10D1040771 CLIA NUMBER - AVON PARK CLUSTER

Laboratory Demographics

CLIA Number: 10D1040771

Facility Name: AVON PARK CLUSTER

Facility Address:
55 E COLLEGE DR
AVON PARK, FL
ZIP 33825
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Facility Phone Number: 863 452-5141

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1225641954

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D1040771
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	AVON PARK CLUSTER
Street	55 E COLLEGE DR
City	AVON PARK
State	FL
ZIP	33825
Phone	863 452-5141
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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