11D2279238 CLIA NUMBER - GATEWAY COMMUNITY SERVICE BOARD MAGNOLIA CENTER FOR AD

Laboratory Demographics

CLIA Number: 11D2279238

Facility Name: GATEWAY COMMUNITY SERVICE BOARD MAGNOLIA CENTER FOR AD

Facility Address:
800 EAST 70TH STREET
SAVANNAH, GA
ZIP 31405
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Facility Phone Number: 912 790-6500

Facility Type: Other - SUD/AD OUTPATIENT CLINIC

Certificate Type: Waiver

NPI Number: 1962584193

Taxonomy: 3336S0011X - Pharmacy
A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.

CLIA Record

Field Name	Field Value
CLIA Number	11D2279238
LAB Type	Other - SUD/AD OUTPATIENT CLINIC
Facility Name	GATEWAY COMMUNITY SERVICE BOARD MAGNOLIA CENTER FOR AD
Street	800 EAST 70TH STREET
City	SAVANNAH
State	GA
ZIP	31405
Phone	912 790-6500
CertificateType	4
CertificateEffectiveDate	3/31/2023
CertificateExpirationDate	3/30/2025
FacilityType	Waiver

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