10D2139606 CLIA NUMBER - CAMPUS RECOVERY LLC

Laboratory Demographics

CLIA Number: 10D2139606

Facility Name: CAMPUS RECOVERY LLC

Facility Address:
19 S DIXIE HWY
LAKE WORTH, FL
ZIP 33460
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Facility Phone Number: 877 995-0102

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1568986958

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

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
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

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