10D2033865 CLIA NUMBER - INTERNATIONAL ASSOC OF TRAUMA & ADDICTION COUNSELORS INC DBA IATAC

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Laboratory Demographics

CLIA Number: 10D2033865

Facility Name: INTERNATIONAL ASSOC OF TRAUMA & ADDICTION COUNSELORS INC DBA IATAC

Facility Address:
4101 S HOSPITAL DRIVE STE 15
PLANTATION, FL
ZIP 33317
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Facility Phone Number: 914 954-1347

Facility Type: Other - IDP

Certificate Type: Waiver

NPI Number: 1528290590

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2033865
LAB Type	Other - IDP
Facility Name	INTERNATIONAL ASSOC OF TRAUMA & ADDICTION COUNSELORS INC DBA IATAC
Street	4101 S HOSPITAL DRIVE STE 15
City	PLANTATION
State	FL
ZIP	33317
Phone	914 954-1347
CertificateType	4
CertificateEffectiveDate	12/12/2023
CertificateExpirationDate	12/11/2025
FacilityType	Waiver

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