44D2033054 CLIA NUMBER - INTEGRATIVE LIFE CENTER

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Laboratory Demographics

CLIA Number: 44D2033054

Facility Name: INTEGRATIVE LIFE CENTER

Facility Address:
1104 16TH AVE SOUTH
NASHVILLE, TN
ZIP 37212
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Facility Phone Number: 615 891-2226

Facility Type: Other - SUBSTANCE DEPENDENCE IOP

Certificate Type: Waiver

NPI Number: 1588296131

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2033054
LAB Type	Other - SUBSTANCE DEPENDENCE IOP
Facility Name	INTEGRATIVE LIFE CENTER
Street	1104 16TH AVE SOUTH
City	NASHVILLE
State	TN
ZIP	37212
Phone	615 891-2226
CertificateType	4
CertificateEffectiveDate	11/22/2023
CertificateExpirationDate	11/21/2025
FacilityType	Waiver

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