18D2135941 CLIA NUMBER - PENNYROYAL CENTER GENESIS WEST

Laboratory Demographics

CLIA Number: 18D2135941

Facility Name: PENNYROYAL CENTER GENESIS WEST

Facility Address:
290 BURLEY AVENUE
HOPKINSVILLE, KY
ZIP 42240
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Facility Phone Number: 270 707-2098

Facility Type: Other - SUBSTANCE ABUSE

Certificate Type: Waiver

NPI Number: 1124319942

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2135941
LAB Type	Other - SUBSTANCE ABUSE
Facility Name	PENNYROYAL CENTER GENESIS WEST
Street	290 BURLEY AVENUE
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 707-2098
CertificateType	4
CertificateEffectiveDate	8/30/2023
CertificateExpirationDate	8/29/2025
FacilityType	Waiver

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