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34D0675740 CLIA NUMBER - COMSERV CREEKSIDE GROUP HOME

Laboratory Demographics

CLIA Number: 34D0675740

Facility Name: COMSERV CREEKSIDE GROUP HOME

Facility Address:
732 HILLSFORM ST NE
LENOIR, NC
ZIP 28645
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Facility Phone Number: 704 757-0209

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver
NPI Number: 1609909662

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name Field Value
CLIA Number 34D0675740
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name COMSERV CREEKSIDE GROUP HOME
Street 732 HILLSFORM ST NE
City LENOIR
State NC
ZIP 28645
Phone 704 757-0209
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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