10D2158379 CLIA NUMBER - ST JOHNS RECOVERY PLACE LLC

Laboratory Demographics

  • CLIA Code: 10D2158379
  • Facility Name: ST JOHNS RECOVERY PLACE LLC
  • Facility Address: 1125 N SUMMIT ST
    CRESCENT CITY, FL
    ZIP 32112
  • Facility Phone: 954 945-2984
  • Facility Type: Other - SUBS ABUSE CENTER
  • Facility Type: Waiver
  • Lab Director: MICHELLE SMITH
  • NPI Number: 1215429436
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2158379
LAB Type Other - SUBS ABUSE CENTER
Facility Name ST JOHNS RECOVERY PLACE LLC
Street 1125 N SUMMIT ST
City CRESCENT CITY
State FL
ZIP 32112
Phone 954 945-2984
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Other - SUBS ABUSE CENTER
Lab Director MICHELLE SMITH

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