13D2276428 CLIA NUMBER - HERITAGE HEALTH ADDICTION SERVICES COEUR D'ALENE

Laboratory Demographics

CLIA Number: 13D2276428

Facility Name: HERITAGE HEALTH ADDICTION SERVICES COEUR D'ALENE

Facility Address:
2205 IRONWOOD PLACE
COEUR D'ALENE, ID
ZIP 83814
Get Directions

Facility Phone Number: 208 664-8347

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1447305610

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2276428
LAB Type	Federally Qualified Health Center
Facility Name	HERITAGE HEALTH ADDICTION SERVICES COEUR D'ALENE
Street	2205 IRONWOOD PLACE
City	COEUR D'ALENE
State	ID
ZIP	83814
Phone	208 664-8347
CertificateType	4
CertificateEffectiveDate	2/8/2023
CertificateExpirationDate	2/7/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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