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51D1048694 CLIA NUMBER - SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CTR MERCER MCDOWELL WYOMING MENTAL HEALTH COUNCIL INC

Laboratory Demographics

CLIA Number: 51D1048694

Facility Name: SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CTR MERCER MCDOWELL WYOMING MENTAL HEALTH COUNCIL INC

Facility Address:
200 12TH STREET EXTENSION
PRINCETON, WV
ZIP 24740
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Facility Phone Number: 304 425-9541

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver
NPI Number: 1205476488

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 51D1048694
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CTR MERCER MCDOWELL WYOMING MENTAL HEALTH COUNCIL INC
Street 200 12TH STREET EXTENSION
City PRINCETON
State WV
ZIP 24740
Phone 304 425-9541
CertificateType 4
CertificateEffectiveDate 12/8/2023
CertificateExpirationDate 12/7/2025
FacilityType Waiver

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