33D2200970 CLIA NUMBER - CONCOURSE MEDICAL CENTER INC

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Laboratory Demographics

CLIA Number: 33D2200970

Facility Name: CONCOURSE MEDICAL CENTER INC

Facility Address:
880 MORRIS AVE
BRONX, NY
ZIP 10451
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Facility Phone Number: 718 665-9340

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1073722286

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	33D2200970
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	CONCOURSE MEDICAL CENTER INC
Street	880 MORRIS AVE
City	BRONX
State	NY
ZIP	10451
Phone	718 665-9340
CertificateType	4
CertificateEffectiveDate	11/18/2020
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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