31D2205986 CLIA NUMBER - EASTERN CHRISTIAN CHILDREN'S RETREAT

Laboratory Demographics

CLIA Code: 31D2205986
Facility Name: EASTERN CHRISTIAN CHILDREN'S RETREAT
Facility Address: 700 MOUNTAIN AVE
WYCKOFF, NJ
ZIP 07481
Facility Phone: 201 848-8005
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: GREGORY COSTELLO
NPI Number: 1447782164
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	31D2205986
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	EASTERN CHRISTIAN CHILDREN'S RETREAT
Street	700 MOUNTAIN AVE
City	WYCKOFF
State	NJ
ZIP	07481
Phone	201 848-8005
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/16/2024
Certificate Expiration Date	12/15/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	GREGORY COSTELLO

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