49D2152693 CLIA NUMBER - BHG XLII, LLC DBA BHG GLEN ALLEN TREATMENT CENTER

Laboratory Demographics

CLIA Number: 49D2152693

Facility Name: BHG XLII, LLC DBA BHG GLEN ALLEN TREATMENT CENTER

Facility Address:
13100 MOUNTAIN RD
GLEN ALLEN, VA
ZIP 23059
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Facility Phone Number: 804 510-0556

Facility Type: Other - OUTPT OPIOID TREATMENT

Certificate Type: Waiver

NPI Number: 1932696770

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D2152693
LAB Type	Other - OUTPT OPIOID TREATMENT
Facility Name	BHG XLII, LLC DBA BHG GLEN ALLEN TREATMENT CENTER
Street	13100 MOUNTAIN RD
City	GLEN ALLEN
State	VA
ZIP	23059
Phone	804 510-0556
CertificateType	4
CertificateEffectiveDate	8/14/2022
CertificateExpirationDate	8/13/2024
FacilityType	Waiver

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