10D2030952 CLIA NUMBER - CHILDRENS DIAGNOSTIC AND TREATMENT CENTER INC

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Laboratory Demographics

CLIA Number: 10D2030952

Facility Name: CHILDRENS DIAGNOSTIC AND TREATMENT CENTER INC

Facility Address:
1401 S FEDERAL HWY
FORT LAUDERDALE, FL
ZIP 33316
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Facility Phone Number: 954 728-8080

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1699907832

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	10D2030952
LAB Type	Community Clinic
Facility Name	CHILDRENS DIAGNOSTIC AND TREATMENT CENTER INC
Street	1401 S FEDERAL HWY
City	FORT LAUDERDALE
State	FL
ZIP	33316
Phone	954 728-8080
CertificateType	4
CertificateEffectiveDate	10/10/2023
CertificateExpirationDate	10/9/2025
FacilityType	Waiver

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