51D2200135 CLIA NUMBER - MOUNTAINEER WELLNESS & RECOVERY CENTERS, LLC

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Laboratory Demographics

CLIA Number: 51D2200135

Facility Name: MOUNTAINEER WELLNESS & RECOVERY CENTERS, LLC

Facility Address:
118 TAYLOR LANE
RONCEVERTE, WV
ZIP 24970
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Facility Phone Number: 681 207-3652

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013557982

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	51D2200135
LAB Type	Physician Office
Facility Name	MOUNTAINEER WELLNESS & RECOVERY CENTERS, LLC
Street	118 TAYLOR LANE
City	RONCEVERTE
State	WV
ZIP	24970
Phone	681 207-3652
CertificateType	4
CertificateEffectiveDate	11/13/2022
CertificateExpirationDate	11/12/2024
FacilityType	Waiver

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