39D2148917 CLIA NUMBER - BANYAN PHILADELPHIA LLC

Laboratory Demographics

  • CLIA Code: 39D2148917
  • Facility Name: BANYAN PHILADELPHIA LLC
  • Facility Address: 100 N BUCKSTOWN DR E-100
    LANGHORNE, PA
    ZIP 19047
  • Facility Phone: 954 533-7705
  • Facility Type: Other - SUBSTANCE TRTMT
  • Facility Type: Waiver
  • Lab Director: DR. DARRIN R. MANGIACARNE
  • NPI Number: 1780101691
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 39D2148917
LAB Type Other - SUBSTANCE TRTMT
Facility Name BANYAN PHILADELPHIA LLC
Street 100 N BUCKSTOWN DR E-100
City LANGHORNE
State PA
ZIP 19047
Phone 954 533-7705
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Other - SUBSTANCE TRTMT
Lab Director DR. DARRIN R. MANGIACARNE

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This page was last updated on: 9/29/2025