33D1020880 CLIA NUMBER - SAINT REGIS MOHAWK HEALTH SERVICES ALCOHOL/ CHEMICAL DEPENDENCY PROGRAM

Laboratory Demographics

  • CLIA Code: 33D1020880
  • Facility Name: SAINT REGIS MOHAWK HEALTH SERVICES ALCOHOL/ CHEMICAL DEPENDENCY PROGRAM
  • Facility Address: 412 STATE ST - RTE 37
    AKWESASNE, NY
    ZIP 13655
  • Facility Phone: 518 358-3141
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DR. LEONARDO DISHMAN
  • NPI Number: 1457344558
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D1020880
LAB Type Comp. Outpatient Rehab Facility
Facility Name SAINT REGIS MOHAWK HEALTH SERVICES ALCOHOL/ CHEMICAL DEPENDENCY PROGRAM
Street 412 STATE ST - RTE 37
City AKWESASNE
State NY
ZIP 13655
Phone 518 358-3141
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2006
Certificate Expiration Date 3/26/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director DR. LEONARDO DISHMAN

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