10D2176100 CLIA NUMBER - INTREPID DETOX RESIDENTIAL LLC

Laboratory Demographics

  • CLIA Code: 10D2176100
  • Facility Name: INTREPID DETOX RESIDENTIAL LLC
  • Facility Address: 1120 48TH STREET
    MANGONIA PARK, FL
    ZIP 33407
  • Facility Phone: 646 645-7773
  • Facility Type: Other - SUBSTANCE ABUSE FACILITY
  • Facility Type: Waiver
  • Lab Director: JOHN PAKEL
  • NPI Number: 1275176497
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2176100
LAB Type Other - SUBSTANCE ABUSE FACILITY
Facility Name INTREPID DETOX RESIDENTIAL LLC
Street 1120 48TH STREET
City MANGONIA PARK
State FL
ZIP 33407
Phone 646 645-7773
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Other - SUBSTANCE ABUSE FACILITY
Lab Director JOHN PAKEL

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