18D2120455 CLIA NUMBER - CLEANSE CLINIC PSC

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Laboratory Demographics

CLIA Number: 18D2120455

Facility Name: CLEANSE CLINIC PSC

Facility Address:
645 S ROY WILKINS AVE, STE 100
LOUISVILLE, KY
ZIP 40203
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Facility Phone Number: 502 561-0943

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1659726628

Taxonomy: 2084P0802X - Psychiatry & Neurology
Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.

CLIA Record

Field Name	Field Value
CLIA Number	18D2120455
LAB Type	Physician Office
Facility Name	CLEANSE CLINIC PSC
Street	645 S ROY WILKINS AVE, STE 100
City	LOUISVILLE
State	KY
ZIP	40203
Phone	502 561-0943
CertificateType	2
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Compliance

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