21D2171348 CLIA NUMBER - BROOK LANE BEHAVIORAL SERVICES, INC

Laboratory Demographics

CLIA Number: 21D2171348

Facility Name: BROOK LANE BEHAVIORAL SERVICES, INC

Facility Address:
18714 NORTH VILLAGE
HAGERSTOWN, MD
ZIP 21742
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Facility Phone Number: 301 733-0330

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417928151

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2171348
LAB Type	Physician Office
Facility Name	BROOK LANE BEHAVIORAL SERVICES, INC
Street	18714 NORTH VILLAGE
City	HAGERSTOWN
State	MD
ZIP	21742
Phone	301 733-0330
CertificateType	4
CertificateEffectiveDate	8/29/2023
CertificateExpirationDate	8/28/2025
FacilityType	Waiver

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