18D0990768 CLIA NUMBER - ACSR INC DBA ACTIVE DAY OF RUSSELL SPRINGS

Laboratory Demographics

CLIA Number: 18D0990768

Facility Name: ACSR INC DBA ACTIVE DAY OF RUSSELL SPRINGS

Facility Address:
552 STEVE DR
RUSSELL SPRINGS, KY
ZIP 42642
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Facility Phone Number: 270 866-4877

Facility Type: Other - ADHC

Certificate Type: Waiver

NPI Number: 1316086853

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D0990768
LAB Type	Other - ADHC
Facility Name	ACSR INC DBA ACTIVE DAY OF RUSSELL SPRINGS
Street	552 STEVE DR
City	RUSSELL SPRINGS
State	KY
ZIP	42642
Phone	270 866-4877
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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