13D2301117 CLIA NUMBER - INNERCEPT LLC

Laboratory Demographics

CLIA Code: 13D2301117
Facility Name: INNERCEPT LLC
Facility Address: 1028 NORTH 14TH ST
COEUR D'ALENE, ID
ZIP 83814
Facility Phone: 208 665-7178
Facility Type: Other - RESIDENTIAL TREATMENT CTR
Facility Type: Waiver
Lab Director: SARAH STEVENS
NPI Number: 1003086653
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	13D2301117
LAB Type	Other - RESIDENTIAL TREATMENT CTR
Facility Name	INNERCEPT LLC
Street	1028 NORTH 14TH ST
City	COEUR D'ALENE
State	ID
ZIP	83814
Phone	208 665-7178
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/21/2024
Certificate Expiration Date	3/20/2026
Facility Type	Other - RESIDENTIAL TREATMENT CTR
Lab Director	SARAH STEVENS

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