15D2148766 CLIA NUMBER - VALLE VISTA HOSPITAL LLC

Laboratory Demographics

CLIA Number: 15D2148766

Facility Name: VALLE VISTA HOSPITAL LLC

Facility Address:
65 AIRPORT PARKWAY SUITE 104
GREENWOOD, IN
ZIP 46143
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Facility Phone Number: 317 887-1348

Facility Type: Other - OPIOID TREATMENT PROGRAM

Certificate Type: Waiver

NPI Number: 1699722405

Taxonomy: 283Q00000X - Psychiatric Hospital
An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.

CLIA Record

Field Name	Field Value
CLIA Number	15D2148766
LAB Type	Other - OPIOID TREATMENT PROGRAM
Facility Name	VALLE VISTA HOSPITAL LLC
Street	65 AIRPORT PARKWAY SUITE 104
City	GREENWOOD
State	IN
ZIP	46143
Phone	317 887-1348
CertificateType	4
CertificateEffectiveDate	5/18/2022
CertificateExpirationDate	5/17/2024
FacilityType	Waiver

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