14D2090499 CLIA NUMBER - COMMUNITY RESOURCE CENTER

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Laboratory Demographics

CLIA Number: 14D2090499

Facility Name: COMMUNITY RESOURCE CENTER

Facility Address:
421 W MAIN
VANDALIA, IL
ZIP 62471
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Facility Phone Number: 618 283-4229

Facility Type: Other - OTPT SUBSTANCE ABUSE CTR

Certificate Type: Waiver

NPI Number: 1184850349

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2090499
LAB Type	Other - OTPT SUBSTANCE ABUSE CTR
Facility Name	COMMUNITY RESOURCE CENTER
Street	421 W MAIN
City	VANDALIA
State	IL
ZIP	62471
Phone	618 283-4229
CertificateType	4
CertificateEffectiveDate	1/26/2023
CertificateExpirationDate	1/25/2025
FacilityType	Waiver

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