18D2119759 CLIA NUMBER - GEORGETOWN MEDICAL, LLC

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Laboratory Demographics

CLIA Number: 18D2119759

Facility Name: GEORGETOWN MEDICAL, LLC

Facility Address:
105 EASTSIDE DRIVE
GEORGETOWN, KY
ZIP 40324
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Facility Phone Number: 502 868-0664

Facility Type: Other - ALCOHOL AND DRUG TREATMEN

Certificate Type: Waiver

NPI Number: 1063824381

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	18D2119759
LAB Type	Other - ALCOHOL AND DRUG TREATMEN
Facility Name	GEORGETOWN MEDICAL, LLC
Street	105 EASTSIDE DRIVE
City	GEORGETOWN
State	KY
ZIP	40324
Phone	502 868-0664
CertificateType	4
CertificateEffectiveDate	10/4/2022
CertificateExpirationDate	10/3/2024
FacilityType	Waiver

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