10D2180389 CLIA NUMBER - BREVARD OUTPATIENT ALTERNATIVE TREATMENT

Laboratory Demographics

  • CLIA Code: 10D2180389
  • Facility Name: BREVARD OUTPATIENT ALTERNATIVE TREATMENT
  • Facility Address: 1227 S PATRICK DRIVE SUITE 108
    SATELLITE BEACH, FL
    ZIP 32937
  • Facility Phone: 321 773-1111
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: GWEN A. MUNDORF
  • NPI Number: 1275692204
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 10D2180389
LAB Type Comp. Outpatient Rehab Facility
Facility Name BREVARD OUTPATIENT ALTERNATIVE TREATMENT
Street 1227 S PATRICK DRIVE SUITE 108
City SATELLITE BEACH
State FL
ZIP 32937
Phone 321 773-1111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director GWEN A. MUNDORF

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