10D2111360 CLIA NUMBER - COASTAL DETOX

Laboratory Demographics

  • CLIA Code: 10D2111360
  • Facility Name: COASTAL DETOX
  • Facility Address: 1131 SE INDIAN ST
    STUART, FL
    ZIP 34997
  • Facility Phone: 772 219-1355
  • Facility Type: Other - INPATIENT DETOX
  • Facility Type: Waiver
  • Lab Director: CHRISTINA TUCKER
  • NPI Number: 1598130098
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2111360
LAB Type Other - INPATIENT DETOX
Facility Name COASTAL DETOX
Street 1131 SE INDIAN ST
City STUART
State FL
ZIP 34997
Phone 772 219-1355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2024
Certificate Expiration Date 4/4/2026
Facility Type Other - INPATIENT DETOX
Lab Director CHRISTINA TUCKER

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This page was last updated on: 9/29/2025