18D2244142 CLIA NUMBER - PANACEA HEALTH CARE LLC

Laboratory Demographics

CLIA Number: 18D2244142

Facility Name: PANACEA HEALTH CARE LLC

Facility Address:
140 KINGS DAUGHTER DRIVE
FRANKFORT, KY
ZIP 40601
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Facility Phone Number: 502 219-2603

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700541646

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	18D2244142
LAB Type	Physician Office
Facility Name	PANACEA HEALTH CARE LLC
Street	140 KINGS DAUGHTER DRIVE
City	FRANKFORT
State	KY
ZIP	40601
Phone	502 219-2603
CertificateType	4
CertificateEffectiveDate	11/29/2023
CertificateExpirationDate	11/28/2025
FacilityType	Waiver

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