14D2084908 CLIA NUMBER - ALCOHOLIC REHABILITATION COMMUNITY HOME (ARCH)

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Laboratory Demographics

CLIA Number: 14D2084908

Facility Name: ALCOHOLIC REHABILITATION COMMUNITY HOME (ARCH)

Facility Address:
1313 21ST ST
GRANITE CITY, IL
ZIP 62040
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Facility Phone Number: 618 877-4987

Facility Type: Other - DASA LICENSED FACILITY

Certificate Type: Waiver

NPI Number: 1891910709

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	14D2084908
LAB Type	Other - DASA LICENSED FACILITY
Facility Name	ALCOHOLIC REHABILITATION COMMUNITY HOME (ARCH)
Street	1313 21ST ST
City	GRANITE CITY
State	IL
ZIP	62040
Phone	618 877-4987
CertificateType	4
CertificateEffectiveDate	10/3/2022
CertificateExpirationDate	10/2/2024
FacilityType	Waiver

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