23D2164349 CLIA NUMBER - INSTITUTE OF SUPPORTIVE SERVICES INC

Laboratory Demographics

CLIA Number: 23D2164349

Facility Name: INSTITUTE OF SUPPORTIVE SERVICES INC

Facility Address:
19940 CONANT SUITE B
DETROIT, MI
ZIP 48234
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Facility Phone Number: 313 733-4528

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346613403

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	23D2164349
LAB Type	Physician Office
Facility Name	INSTITUTE OF SUPPORTIVE SERVICES INC
Street	19940 CONANT SUITE B
City	DETROIT
State	MI
ZIP	48234
Phone	313 733-4528
CertificateType	4
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Waiver

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