52D0931324 CLIA NUMBER - MILWAUKEE HEALTH SERVICE SYSTEMS, LLC DBA MADISON EAST COMPREHENSIVE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 52D0931324

Facility Name: MILWAUKEE HEALTH SERVICE SYSTEMS, LLC DBA MADISON EAST COMPREHENSIVE TREATMENT CENTER

Facility Address:
5109 WORLD DAIRY DR
MADISON, WI
ZIP 53718
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Facility Phone Number: 608 242-0220

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1801947965

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	52D0931324
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	MILWAUKEE HEALTH SERVICE SYSTEMS, LLC DBA MADISON EAST COMPREHENSIVE TREATMENT CENTER
Street	5109 WORLD DAIRY DR
City	MADISON
State	WI
ZIP	53718
Phone	608 242-0220
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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