36D2026176 CLIA NUMBER - DR GINA REGHETTI DO PC INC ACUTE OPIOID DETOX CLINIC USA

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Laboratory Demographics

CLIA Number: 36D2026176

Facility Name: DR GINA REGHETTI DO PC INC ACUTE OPIOID DETOX CLINIC USA

Facility Address:
THE 110 BUILDING 110 EDWARD STREET NW
WARREN, OH
ZIP 44483
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Facility Phone Number: 330 847-3334

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841569902

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2026176
LAB Type	Physician Office
Facility Name	DR GINA REGHETTI DO PC INC ACUTE OPIOID DETOX CLINIC USA
Street	THE 110 BUILDING 110 EDWARD STREET NW
City	WARREN
State	OH
ZIP	44483
Phone	330 847-3334
CertificateType	4
CertificateEffectiveDate	6/24/2023
CertificateExpirationDate	6/23/2025
FacilityType	Waiver

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