19D2290469 CLIA NUMBER - COUNCIL ON ALCOHOLISM AND DRUG ABUSE

Laboratory Demographics

CLIA Number: 19D2290469

Facility Name: COUNCIL ON ALCOHOLISM AND DRUG ABUSE

Facility Address:
1525 FULLILOVE DRIVE
BOSSIER CITY, LA
ZIP 71112
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Facility Phone Number: 318 747-1211

Facility Type: Other - SUBSTANCE ABUSE FACILITY

Certificate Type: Waiver

NPI Number: 1699955815

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	19D2290469
LAB Type	Other - SUBSTANCE ABUSE FACILITY
Facility Name	COUNCIL ON ALCOHOLISM AND DRUG ABUSE
Street	1525 FULLILOVE DRIVE
City	BOSSIER CITY
State	LA
ZIP	71112
Phone	318 747-1211
CertificateType	4
CertificateEffectiveDate	9/26/2023
CertificateExpirationDate	9/25/2025
FacilityType	Waiver

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