49D2202946 CLIA NUMBER - MANASSAS ADDICTION CENTER LLC

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Laboratory Demographics

CLIA Number: 49D2202946

Facility Name: MANASSAS ADDICTION CENTER LLC

Facility Address:
9001 DIGGES ROAD SUITE 104
MANASSAS, VA
ZIP 20110
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Facility Phone Number: 703 239-3602

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1225692015

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D2202946
LAB Type	Practitioner Other
Facility Name	MANASSAS ADDICTION CENTER LLC
Street	9001 DIGGES ROAD SUITE 104
City	MANASSAS
State	VA
ZIP	20110
Phone	703 239-3602
CertificateType	4
CertificateEffectiveDate	12/2/2022
CertificateExpirationDate	12/1/2024
FacilityType	Waiver

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