44D2032797 CLIA NUMBER - CRC HEALTH TENNESSEE, INC DBA MIRROR LAKE RECOVERY CENTER

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Laboratory Demographics

CLIA Number: 44D2032797

Facility Name: CRC HEALTH TENNESSEE, INC DBA MIRROR LAKE RECOVERY CENTER

Facility Address:
999 GIRL SCOUT RD
BURNS, TN
ZIP 37029
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Facility Phone Number: 615 441-5098

Facility Type: Other - RESIDENTIAL TREATMENT FAC

Certificate Type: Waiver

NPI Number: 1770615619

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	44D2032797
LAB Type	Other - RESIDENTIAL TREATMENT FAC
Facility Name	CRC HEALTH TENNESSEE, INC DBA MIRROR LAKE RECOVERY CENTER
Street	999 GIRL SCOUT RD
City	BURNS
State	TN
ZIP	37029
Phone	615 441-5098
CertificateType	4
CertificateEffectiveDate	11/16/2023
CertificateExpirationDate	11/15/2025
FacilityType	Waiver

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