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13D2167774 CLIA NUMBER - RESTORED HORIZONS PAIN MANAGEMENT

Laboratory Demographics

CLIA Number: 13D2167774

Facility Name: RESTORED HORIZONS PAIN MANAGEMENT

Facility Address:
913 W CANFIELD AVE
COEUR D ALENE, ID
ZIP 83815
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Facility Phone Number: 208 819-7103

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1538503693

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name Field Value
CLIA Number 13D2167774
LAB Type Physician Office
Facility Name RESTORED HORIZONS PAIN MANAGEMENT
Street 913 W CANFIELD AVE
City COEUR D ALENE
State ID
ZIP 83815
Phone 208 819-7103
CertificateType 4
CertificateEffectiveDate 6/14/2023
CertificateExpirationDate 6/13/2025
FacilityType Waiver

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