36D2269226 CLIA NUMBER - MIDWEST RECOVERY CENTER

Laboratory Demographics

CLIA Number: 36D2269226

Facility Name: MIDWEST RECOVERY CENTER

Facility Address:
115 W STATE ST
NORTH BALTIMORE, OH
ZIP 45872
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Facility Phone Number: 419 206-0843

Facility Type: Other - BEHAVIORAL HEALTH CENTER

Certificate Type: Waiver

NPI Number: 1407326366

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2269226
LAB Type	Other - BEHAVIORAL HEALTH CENTER
Facility Name	MIDWEST RECOVERY CENTER
Street	115 W STATE ST
City	NORTH BALTIMORE
State	OH
ZIP	45872
Phone	419 206-0843
CertificateType	4
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Waiver

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