36D2192337 CLIA NUMBER - GREAT LAKES RECOVERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 36D2192337

Facility Name: GREAT LAKES RECOVERY CENTER, LLC

Facility Address:
2575 HAYES AVENUE
FREMONT, OH
ZIP 43420
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Facility Phone Number: 419 680-0172

Facility Type: Other - SUD IOP

Certificate Type: Waiver

NPI Number: 1497376735

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	36D2192337
LAB Type	Other - SUD IOP
Facility Name	GREAT LAKES RECOVERY CENTER, LLC
Street	2575 HAYES AVENUE
City	FREMONT
State	OH
ZIP	43420
Phone	419 680-0172
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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