17D0988675 CLIA NUMBER - MOUNDRIDGE VALLEY HOPE

Laboratory Demographics

CLIA Number: 17D0988675

Facility Name: MOUNDRIDGE VALLEY HOPE

Facility Address:
200 S AVENUE B
MOUNDRIDGE, KS
ZIP 67107
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Facility Phone Number: 785 877-5111

Facility Type: Other - SUBSTCE USE DISORDR FAC

Certificate Type: Waiver

NPI Number: 1275569949

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	17D0988675
LAB Type	Other - SUBSTCE USE DISORDR FAC
Facility Name	MOUNDRIDGE VALLEY HOPE
Street	200 S AVENUE B
City	MOUNDRIDGE
State	KS
ZIP	67107
Phone	785 877-5111
CertificateType	4
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	Waiver

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