10D2132695 CLIA NUMBER - PEACE RIVER CENTER - RESIDENTIAL GRP HOMES

Laboratory Demographics

CLIA Number: 10D2132695

Facility Name: PEACE RIVER CENTER - RESIDENTIAL GRP HOMES

Facility Address:
728 EAST BELLA VISTA STREET
LAKELAND, FL
ZIP 33805
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Facility Phone Number: 863 519-0575

Facility Type: Other - MENTAL HEALTH RESIDENTIAL

Certificate Type: Waiver

NPI Number: 1821097767

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2132695
LAB Type	Other - MENTAL HEALTH RESIDENTIAL
Facility Name	PEACE RIVER CENTER - RESIDENTIAL GRP HOMES
Street	728 EAST BELLA VISTA STREET
City	LAKELAND
State	FL
ZIP	33805
Phone	863 519-0575
CertificateType	4
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	Waiver

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