18D2305810 CLIA NUMBER - IMPACT OUTPATIENT PROGRAM, LLC

Laboratory Demographics

  • CLIA Code: 18D2305810
  • Facility Name: IMPACT OUTPATIENT PROGRAM, LLC
  • Facility Address: 1200 N BARDSTOWN ROAD, SUITE A-2
    MOUNT WASHINGTON, KY
    ZIP 40047
  • Facility Phone: 502 439-2248
  • Facility Type: Other - SUBSTANCE USE FACILITY
  • Facility Type: Waiver
  • Lab Director: DR. JORDAN CALABRESE
  • NPI Number: 1972176113
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 18D2305810
LAB Type Other - SUBSTANCE USE FACILITY
Facility Name IMPACT OUTPATIENT PROGRAM, LLC
Street 1200 N BARDSTOWN ROAD, SUITE A-2
City MOUNT WASHINGTON
State KY
ZIP 40047
Phone 502 439-2248
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2024
Certificate Expiration Date 6/5/2026
Facility Type Other - SUBSTANCE USE FACILITY
Lab Director DR. JORDAN CALABRESE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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