35D1062169 CLIA NUMBER - NORTH DAKOTA YOUTH CORRECTIONAL CENTER

Laboratory Demographics

CLIA Number: 35D1062169

Facility Name: NORTH DAKOTA YOUTH CORRECTIONAL CENTER

Facility Address:
701 16TH AVE SW
MANDAN, ND
ZIP 58554
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Facility Phone Number: 701 667-1400

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1790080356

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	35D1062169
LAB Type	Other
Facility Name	NORTH DAKOTA YOUTH CORRECTIONAL CENTER
Street	701 16TH AVE SW
City	MANDAN
State	ND
ZIP	58554
Phone	701 667-1400
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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