21D2198782 CLIA NUMBER - SIBUS TREATMENT SERVICES IOP

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Laboratory Demographics

CLIA Number: 21D2198782

Facility Name: SIBUS TREATMENT SERVICES IOP

Facility Address:
6170 HUNT CLUB RD
ELKRIDGE, MD
ZIP 21075
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Facility Phone Number: 443 820-3234

Facility Type: Other - OUTPATIENT SUB ABUSE TX

Certificate Type: Waiver

NPI Number: 1215587027

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	21D2198782
LAB Type	Other - OUTPATIENT SUB ABUSE TX
Facility Name	SIBUS TREATMENT SERVICES IOP
Street	6170 HUNT CLUB RD
City	ELKRIDGE
State	MD
ZIP	21075
Phone	443 820-3234
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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