10D2019812 CLIA NUMBER - GENESIS HOUSE RECOVERY RESIDENCE INC

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Laboratory Demographics

CLIA Number: 10D2019812

Facility Name: GENESIS HOUSE RECOVERY RESIDENCE INC

Facility Address:
4865 40TH WAY S
LAKE WORTH, FL
ZIP 33461
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Facility Phone Number: 800 737-0933

Facility Type: Other - RESIDENTIAL TREATMENT FAC

Certificate Type: Waiver

NPI Number: 1245383447

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	10D2019812
LAB Type	Other - RESIDENTIAL TREATMENT FAC
Facility Name	GENESIS HOUSE RECOVERY RESIDENCE INC
Street	4865 40TH WAY S
City	LAKE WORTH
State	FL
ZIP	33461
Phone	800 737-0933
CertificateType	4
CertificateEffectiveDate	2/7/2023
CertificateExpirationDate	2/6/2025
FacilityType	Waiver

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