18D2130877 CLIA NUMBER - CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC

Laboratory Demographics

CLIA Number: 18D2130877

Facility Name: CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC

Facility Address:
1700 CARGO COURT
JEFFERSONTOWN, KY
ZIP 40299
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Facility Phone Number: 864 964-7500

Facility Type: Other - METHADONE CLINIC

Certificate Type: Waiver

NPI Number: 1649797507

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	18D2130877
LAB Type	Other - METHADONE CLINIC
Facility Name	CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC
Street	1700 CARGO COURT
City	JEFFERSONTOWN
State	KY
ZIP	40299
Phone	864 964-7500
CertificateType	4
CertificateEffectiveDate	5/18/2023
CertificateExpirationDate	5/17/2025
FacilityType	Waiver

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