38D0699643 CLIA NUMBER - SERENITY LANE

Laboratory Demographics

CLIA Number: 38D0699643

Facility Name: SERENITY LANE

Facility Address:
1 SERENITY LANE
COBURG, OR
ZIP 97408
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Facility Phone Number: 541 687-1110

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1619429396

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	38D0699643
LAB Type	Other
Facility Name	SERENITY LANE
Street	1 SERENITY LANE
City	COBURG
State	OR
ZIP	97408
Phone	541 687-1110
CertificateType	4
CertificateEffectiveDate	7/30/2022
CertificateExpirationDate	7/29/2024
FacilityType	Waiver

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