49D2118932 CLIA NUMBER - CROSSROADS TREATMENT CENTER OF PETERSBURG, PC

Laboratory Demographics

CLIA Number: 49D2118932

Facility Name: CROSSROADS TREATMENT CENTER OF PETERSBURG, PC

Facility Address:
10543 SOUTH CRATER ROAD
PETERSBURG, VA
ZIP 23805
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Facility Phone Number: 864 527-3145

Facility Type: Other - NARCOTIC TREATMENT CENTER

Certificate Type: Waiver

NPI Number: 1255095857

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	49D2118932
LAB Type	Other - NARCOTIC TREATMENT CENTER
Facility Name	CROSSROADS TREATMENT CENTER OF PETERSBURG, PC
Street	10543 SOUTH CRATER ROAD
City	PETERSBURG
State	VA
ZIP	23805
Phone	864 527-3145
CertificateType	4
CertificateEffectiveDate	9/16/2022
CertificateExpirationDate	9/15/2024
FacilityType	Waiver

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