51D2145661 CLIA NUMBER - JACOB'S LADDER AT BROOKSIDE FARM, LLC

Laboratory Demographics

  • CLIA Code: 51D2145661
  • Facility Name: JACOB'S LADDER AT BROOKSIDE FARM, LLC
  • Facility Address: 25308 GEORGE WASHINGTON HIGHWAY
    AURORA, WV
    ZIP 26705
  • Facility Phone: 304 290-0266
  • Facility Type: Other - INPATIENT ADDICTION TREAT
  • Facility Type: Waiver
  • Lab Director: DR. KEVIN J. BLANKENSHIP
  • NPI Number: 1205344355
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 51D2145661
LAB Type Other - INPATIENT ADDICTION TREAT
Facility Name JACOB'S LADDER AT BROOKSIDE FARM, LLC
Street 25308 GEORGE WASHINGTON HIGHWAY
City AURORA
State WV
ZIP 26705
Phone 304 290-0266
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2024
Certificate Expiration Date 3/12/2026
Facility Type Other - INPATIENT ADDICTION TREAT
Lab Director DR. KEVIN J. BLANKENSHIP

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This page was last updated on: 9/29/2025