49D2286057 CLIA NUMBER - VIRGINIA MISSION HEALTH ACQUISITION, LLC

Laboratory Demographics

CLIA Number: 49D2286057

Facility Name: VIRGINIA MISSION HEALTH ACQUISITION, LLC

Facility Address:
10305 BROWNS MILL ROAD
VIENNA, VA
ZIP 22182
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Facility Phone Number: 949 313-4709

Facility Type: Other - RESIDENTIAL MENTAL HLTH

Certificate Type: Waiver

NPI Number: 1396827895

Taxonomy: 261QS1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D2286057
LAB Type	Other - RESIDENTIAL MENTAL HLTH
Facility Name	VIRGINIA MISSION HEALTH ACQUISITION, LLC
Street	10305 BROWNS MILL ROAD
City	VIENNA
State	VA
ZIP	22182
Phone	949 313-4709
CertificateType	4
CertificateEffectiveDate	7/24/2023
CertificateExpirationDate	7/23/2025
FacilityType	Waiver

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