10D2031844 CLIA NUMBER - COMMUNITY REHABILITATION CENTER

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Laboratory Demographics

CLIA Number: 10D2031844

Facility Name: COMMUNITY REHABILITATION CENTER

Facility Address:
623 BEECHWOOD ST
JACKSONVILLE, FL
ZIP 32206
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Facility Phone Number: 904 358-1211

Facility Type: Other - COMMUNITY FAITH BASED ORG

Certificate Type: Waiver

NPI Number: 1407520554

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2031844
LAB Type	Other - COMMUNITY FAITH BASED ORG
Facility Name	COMMUNITY REHABILITATION CENTER
Street	623 BEECHWOOD ST
City	JACKSONVILLE
State	FL
ZIP	32206
Phone	904 358-1211
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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