18D1095947 CLIA NUMBER - LAKE CUMBERLAND CANCER TREATMENT CENTER TABATHA HENSLEY

Laboratory Demographics

  • CLIA Code: 18D1095947
  • Facility Name: LAKE CUMBERLAND CANCER TREATMENT CENTER TABATHA HENSLEY
  • Facility Address: 112 TRADEPARK DRIVE
    SOMERSET, KY
    ZIP 42503
  • Facility Phone: 606 451-3755
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: AMTULLAH KHAN
  • NPI Number: 1013553247
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 18D1095947
LAB Type Other
Facility Name LAKE CUMBERLAND CANCER TREATMENT CENTER TABATHA HENSLEY
Street 112 TRADEPARK DRIVE
City SOMERSET
State KY
ZIP 42503
Phone 606 451-3755
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2025
Certificate Expiration Date 2/19/2027
Facility Type Other
Lab Director AMTULLAH KHAN

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This page was last updated on: 9/29/2025