26D1065190 CLIA NUMBER - GATEWAY FOUNDATION ST LOUIS CORRECTIONS OUTPATIENT PROGRAM

Laboratory Demographics

  • CLIA Code: 26D1065190
  • Facility Name: GATEWAY FOUNDATION ST LOUIS CORRECTIONS OUTPATIENT PROGRAM
  • Facility Address: 1430 OLIVE ST, STE 300
    SAINT LOUIS, MO
    ZIP 63103
  • Facility Phone: 314 421-6188
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: ROUEEN RAFEYAN
  • NPI Number: 1508393216
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D1065190
LAB Type Comp. Outpatient Rehab Facility
Facility Name GATEWAY FOUNDATION ST LOUIS CORRECTIONS OUTPATIENT PROGRAM
Street 1430 OLIVE ST, STE 300
City SAINT LOUIS
State MO
ZIP 63103
Phone 314 421-6188
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director ROUEEN RAFEYAN

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This page was last updated on: 9/29/2025