31D1087722 CLIA NUMBER - CHILDREN'S REGIONAL AT COOPER HOSPITAL - INFECTIOUS DISEASE

Laboratory Demographics

CLIA Number: 31D1087722

Facility Name: CHILDREN'S REGIONAL AT COOPER HOSPITAL - INFECTIOUS DISEASE

Facility Address:
3 COOPER PLAZA, SUITE 200 ATTN SUSAN BURROWS-CLARK
CAMDEN, NJ
ZIP 08103
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Facility Phone Number: 856 342-2617

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730847849

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	31D1087722
LAB Type	Physician Office
Facility Name	CHILDREN'S REGIONAL AT COOPER HOSPITAL - INFECTIOUS DISEASE
Street	3 COOPER PLAZA, SUITE 200 ATTN SUSAN BURROWS-CLARK
City	CAMDEN
State	NJ
ZIP	08103
Phone	856 342-2617
CertificateType	4
CertificateEffectiveDate	8/11/2022
CertificateExpirationDate	8/10/2024
FacilityType	Waiver

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