36D2160906 CLIA NUMBER - SILVER MAPLE RECOVERY

Laboratory Demographics

CLIA Number: 36D2160906

Facility Name: SILVER MAPLE RECOVERY

Facility Address:
2101 ALL PRO ATHLETIC AVENUE
LORAIN, OH
ZIP 44053
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Facility Phone Number: 440 830-3400

Facility Type: Other - IN PATIENT DRUG AND ALCOH

Certificate Type: Waiver

NPI Number: 1124597182

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2160906
LAB Type	Other - IN PATIENT DRUG AND ALCOH
Facility Name	SILVER MAPLE RECOVERY
Street	2101 ALL PRO ATHLETIC AVENUE
City	LORAIN
State	OH
ZIP	44053
Phone	440 830-3400
CertificateType	4
CertificateEffectiveDate	1/22/2023
CertificateExpirationDate	1/21/2025
FacilityType	Waiver

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