18D2045319 CLIA NUMBER - MOUNTAIN COMPREHENSIVE CARE CENTER, INC

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Laboratory Demographics

CLIA Number: 18D2045319

Facility Name: MOUNTAIN COMPREHENSIVE CARE CENTER, INC

Facility Address:
838 SOUTH MAYO TRAIL
PAINTSVILLE, KY
ZIP 41240
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Facility Phone Number: 606 886-8572

Facility Type: Other - CMHC

Certificate Type: Waiver

NPI Number: 1114426863

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2045319
LAB Type	Other - CMHC
Facility Name	MOUNTAIN COMPREHENSIVE CARE CENTER, INC
Street	838 SOUTH MAYO TRAIL
City	PAINTSVILLE
State	KY
ZIP	41240
Phone	606 886-8572
CertificateType	4
CertificateEffectiveDate	8/9/2022
CertificateExpirationDate	8/8/2024
FacilityType	Waiver

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