10D2139606 CLIA NUMBER - CAMPUS RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 10D2139606
  • Facility Name: CAMPUS RECOVERY LLC
  • Facility Address: 19 S DIXIE HWY
    LAKE WORTH, FL
    ZIP 33460
  • Facility Phone: 877 995-0102
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: FRED J. MOLDT
  • NPI Number: 1568986958
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2139606
LAB Type Practitioner Other
Facility Name CAMPUS RECOVERY LLC
Street 19 S DIXIE HWY
City LAKE WORTH
State FL
ZIP 33460
Phone 877 995-0102
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Practitioner Other
Lab Director FRED J. MOLDT

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