10D2002237 CLIA NUMBER - GULF COAST ADDICTION MEDICINE

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Laboratory Demographics

CLIA Number: 10D2002237

Facility Name: GULF COAST ADDICTION MEDICINE

Facility Address:
277 FOREST PARK CIR
PANAMA CITY, FL
ZIP 32405
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Facility Phone Number: 850 522-1516

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1407301757

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	10D2002237
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	GULF COAST ADDICTION MEDICINE
Street	277 FOREST PARK CIR
City	PANAMA CITY
State	FL
ZIP	32405
Phone	850 522-1516
CertificateType	4
CertificateEffectiveDate	1/11/2024
CertificateExpirationDate	1/10/2026
FacilityType	Waiver

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