16D2174804 CLIA NUMBER - COUNCIL BLUFFS COMPREHENSIVE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 16D2174804

Facility Name: COUNCIL BLUFFS COMPREHENSIVE TREATMENT CENTER

Facility Address:
1750 W BROADWAY
COUNCIL BLUFFS, IA
ZIP 51501
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Facility Phone Number: 712 215-6588

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1326689076

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	16D2174804
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	COUNCIL BLUFFS COMPREHENSIVE TREATMENT CENTER
Street	1750 W BROADWAY
City	COUNCIL BLUFFS
State	IA
ZIP	51501
Phone	712 215-6588
CertificateType	4
CertificateEffectiveDate	11/8/2023
CertificateExpirationDate	11/7/2025
FacilityType	Waiver

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