21D2240004 CLIA NUMBER - IMPACT DUI LLC

Laboratory Demographics

CLIA Number: 21D2240004

Facility Name: IMPACT DUI LLC

Facility Address:
1209 LIBERTY RD #102
ELDERSBURG, MD
ZIP 21784
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Facility Phone Number: 410 581-4900

Facility Type: Other - SUBSTANCE USE DISORDER

Certificate Type: Waiver

NPI Number: 1528499498

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	21D2240004
LAB Type	Other - SUBSTANCE USE DISORDER
Facility Name	IMPACT DUI LLC
Street	1209 LIBERTY RD #102
City	ELDERSBURG
State	MD
ZIP	21784
Phone	410 581-4900
CertificateType	4
CertificateEffectiveDate	10/15/2023
CertificateExpirationDate	10/14/2025
FacilityType	Waiver

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