11D2143139 CLIA NUMBER - ATLANTA DETOX CENTER, LLC

Laboratory Demographics

CLIA Number: 11D2143139

Facility Name: ATLANTA DETOX CENTER, LLC

Facility Address:
277 MEDICAL WAY
RIVERDALE, GA
ZIP 30274
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Facility Phone Number: 833 631-0534

Facility Type: Other - SCREEN/URINE ANALYSIS

Certificate Type: Waiver

NPI Number: 1033694864

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	11D2143139
LAB Type	Other - SCREEN/URINE ANALYSIS
Facility Name	ATLANTA DETOX CENTER, LLC
Street	277 MEDICAL WAY
City	RIVERDALE
State	GA
ZIP	30274
Phone	833 631-0534
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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