18D2120455 CLIA NUMBER - CLEANSE CLINIC PSC

Laboratory Demographics

  • CLIA Code: 18D2120455
  • Facility Name: CLEANSE CLINIC PSC
  • Facility Address: 645 S ROY WILKINS AVE
    LOUISVILLE, KY
    ZIP 40203
  • Facility Phone: 502 561-0943
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. MATTHEW RYCENGA
  • NPI Number: 1659726628
  • Taxonomy: 2084P0802X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 18D2120455
LAB Type Independent
Facility Name CLEANSE CLINIC PSC
Street 645 S ROY WILKINS AVE
City LOUISVILLE
State KY
ZIP 40203
Phone 502 561-0943
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Independent
Lab Director DR. MATTHEW RYCENGA

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