38D2253536 CLIA NUMBER - TELECARE 72ND AVE RECOVERY CENTER

Laboratory Demographics

CLIA Code: 38D2253536
Facility Name: TELECARE 72ND AVE RECOVERY CENTER
Facility Address: 7759 SE 72ND AVE
PORTLAND, OR
ZIP 97206
Facility Phone: 503 788-4500
Facility Type: Other - RESIDENTIAL TREATMENT FAC
Facility Type: Waiver
Lab Director: SCOTT C. TUCKER
NPI Number: 1659453686
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	38D2253536
LAB Type	Other - RESIDENTIAL TREATMENT FAC
Facility Name	TELECARE 72ND AVE RECOVERY CENTER
Street	7759 SE 72ND AVE
City	PORTLAND
State	OR
ZIP	97206
Phone	503 788-4500
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/22/2024
Certificate Expiration Date	2/21/2026
Facility Type	Other - RESIDENTIAL TREATMENT FAC
Lab Director	SCOTT C. TUCKER

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This page was last updated on: 6/4/2025