18D2277774 CLIA NUMBER - EAST KENTUCKY RECOVERY

Laboratory Demographics

CLIA Number: 18D2277774

Facility Name: EAST KENTUCKY RECOVERY

Facility Address:
1337 HIGHWAY 119 NORTH
WHITESBURG, KY
ZIP 41858
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Facility Phone Number: 606 403-1041

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528768801

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2277774
LAB Type	Physician Office
Facility Name	EAST KENTUCKY RECOVERY
Street	1337 HIGHWAY 119 NORTH
City	WHITESBURG
State	KY
ZIP	41858
Phone	606 403-1041
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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