25D2129737 CLIA NUMBER - JACKSON COMPREHENSIVE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 25D2129737

Facility Name: JACKSON COMPREHENSIVE TREATMENT CENTER

Facility Address:
1935 LAKELAND DR STE 900
JACKSON, MS
ZIP 39216
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Facility Phone Number: 601 718-2468

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1629510540

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	25D2129737
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	JACKSON COMPREHENSIVE TREATMENT CENTER
Street	1935 LAKELAND DR STE 900
City	JACKSON
State	MS
ZIP	39216
Phone	601 718-2468
CertificateType	4
CertificateEffectiveDate	4/25/2023
CertificateExpirationDate	4/24/2025
FacilityType	Waiver

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