44D2043141 CLIA NUMBER - VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER

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Laboratory Demographics

CLIA Number: 44D2043141

Facility Name: VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER

Facility Address:
58 CARRIAGE HOUSE DR STE B
JACKSON, TN
ZIP 38305
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Facility Phone Number: 731 660-0880

Facility Type: Other - OUTPATIENT TREATMENT

Certificate Type: Waiver

NPI Number: 1639515646

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2043141
LAB Type	Other - OUTPATIENT TREATMENT
Facility Name	VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER
Street	58 CARRIAGE HOUSE DR STE B
City	JACKSON
State	TN
ZIP	38305
Phone	731 660-0880
CertificateType	4
CertificateEffectiveDate	6/28/2022
CertificateExpirationDate	6/27/2024
FacilityType	Waiver

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