42D1097894 CLIA NUMBER - CROSSROADS TREATMENT CENTER OF GREENVILLE, PC

Laboratory Demographics

CLIA Number: 42D1097894

Facility Name: CROSSROADS TREATMENT CENTER OF GREENVILLE, PC

Facility Address:
157 BROZZINI CT, SUITE A
GREENVILLE, SC
ZIP 29615
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Facility Phone Number: 864 288-7636

Facility Type: Other - METHADONE CLINIC

Certificate Type: Waiver

NPI Number: 1538601414

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D1097894
LAB Type	Other - METHADONE CLINIC
Facility Name	CROSSROADS TREATMENT CENTER OF GREENVILLE, PC
Street	157 BROZZINI CT, SUITE A
City	GREENVILLE
State	SC
ZIP	29615
Phone	864 288-7636
CertificateType	4
CertificateEffectiveDate	4/7/2023
CertificateExpirationDate	4/6/2025
FacilityType	Waiver

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