18D2222564 CLIA NUMBER - A NEWCO LLC DBA KENTUCKIANA CENTER FOR ADDICTION MEDICINE

Laboratory Demographics

  • CLIA Code: 18D2222564
  • Facility Name: A NEWCO LLC DBA KENTUCKIANA CENTER FOR ADDICTION MEDICINE
  • Facility Address: 1939 GOLDSMITH LN, STE 100
    LOUISVILLE, KY
    ZIP 40218
  • Facility Phone: 502 873-7517
  • Facility Type: Other - AODE
  • Facility Type: Waiver
  • Lab Director: MS. SUSAN K. BALLARD
  • NPI Number: 1285103937
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 18D2222564
LAB Type Other - AODE
Facility Name A NEWCO LLC DBA KENTUCKIANA CENTER FOR ADDICTION MEDICINE
Street 1939 GOLDSMITH LN, STE 100
City LOUISVILLE
State KY
ZIP 40218
Phone 502 873-7517
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Other - AODE
Lab Director MS. SUSAN K. BALLARD

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