39D2121856 CLIA NUMBER - MEDMARK TRT CTRS/PA INC/BLAIRSVILLE PA

Laboratory Demographics

CLIA Number: 39D2121856

Facility Name: MEDMARK TRT CTRS/PA INC/BLAIRSVILLE PA

Facility Address:
1984 ROUTE 22
BLAIRSVILLE, PA
ZIP 15717
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Facility Phone Number: 412 901-9079

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1952854408

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	39D2121856
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	MEDMARK TRT CTRS/PA INC/BLAIRSVILLE PA
Street	1984 ROUTE 22
City	BLAIRSVILLE
State	PA
ZIP	15717
Phone	412 901-9079
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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