46D2048587 CLIA NUMBER - LIFELINE BEHAVIORAL HEALTH, LLC

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Laboratory Demographics

CLIA Number: 46D2048587

Facility Name: LIFELINE BEHAVIORAL HEALTH, LLC

Facility Address:
1130 WEST CENTER STREET
NORTH SALT LAKE, UT
ZIP 84054
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Facility Phone Number: 801 936-4000

Facility Type: Other - RESIDENTIAL TREATMENT

Certificate Type: Waiver

NPI Number: 1780884742

Taxonomy: 3245S0500X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility for children that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included.

CLIA Record

Field Name	Field Value
CLIA Number	46D2048587
LAB Type	Other - RESIDENTIAL TREATMENT
Facility Name	LIFELINE BEHAVIORAL HEALTH, LLC
Street	1130 WEST CENTER STREET
City	NORTH SALT LAKE
State	UT
ZIP	84054
Phone	801 936-4000
CertificateType	4
CertificateEffectiveDate	10/18/2022
CertificateExpirationDate	10/17/2024
FacilityType	Waiver

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