20D2151946 CLIA NUMBER - PINE TREE RECOVERY CENTER

Laboratory Demographics

  • CLIA Code: 20D2151946
  • Facility Name: PINE TREE RECOVERY CENTER
  • Facility Address: 17 BISHOP STREET
    PORTLAND, ME
    ZIP 04103
  • Facility Phone: 207 618-9611
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: BORIS GOLOSARSKY
  • NPI Number: 1205228590
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 20D2151946
LAB Type Ancillary Testing Site in Health Care Center
Facility Name PINE TREE RECOVERY CENTER
Street 17 BISHOP STREET
City PORTLAND
State ME
ZIP 04103
Phone 207 618-9611
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director BORIS GOLOSARSKY

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This page was last updated on: 6/4/2025