22D2179494 CLIA NUMBER - CLEANSLATE CENTERS

Laboratory Demographics

CLIA Number: 22D2179494

Facility Name: CLEANSLATE CENTERS

Facility Address:
77 HOSPITAL AVE SUITE 107
NORTH ADAMS, MA
ZIP 01247
Get Directions

Facility Phone Number: 413 584-2173

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326585662

Taxonomy: 207RA0401X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

CLIA Record

Field Name	Field Value
CLIA Number	22D2179494
LAB Type	Physician Office
Facility Name	CLEANSLATE CENTERS
Street	77 HOSPITAL AVE SUITE 107
City	NORTH ADAMS
State	MA
ZIP	01247
Phone	413 584-2173
CertificateType	4
CertificateEffectiveDate	2/25/2024
CertificateExpirationDate	2/24/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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