32D2179728 CLIA NUMBER - SHADOW MOUNTAIN RECOVERY

Laboratory Demographics

CLIA Number: 32D2179728

Facility Name: SHADOW MOUNTAIN RECOVERY

Facility Address:
7005 PROSPECT PLACE NE
ALBUQUERQUE, NM
ZIP 87110
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Facility Phone Number: 505 361-2634

Facility Type: Other - SUBSTANCE ABUSE TREATMENT

Certificate Type: Waiver

NPI Number: 1487226031

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2179728
LAB Type	Other - SUBSTANCE ABUSE TREATMENT
Facility Name	SHADOW MOUNTAIN RECOVERY
Street	7005 PROSPECT PLACE NE
City	ALBUQUERQUE
State	NM
ZIP	87110
Phone	505 361-2634
CertificateType	4
CertificateEffectiveDate	2/29/2024
CertificateExpirationDate	2/27/2026
FacilityType	Waiver

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