53D2022866 CLIA NUMBER - S48WY1 LLC, DBA/WYOMING RECOVERY

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Laboratory Demographics

CLIA Number: 53D2022866

Facility Name: S48WY1 LLC, DBA/WYOMING RECOVERY

Facility Address:
231 S WILSON ST
CASPER, WY
ZIP 82601
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Facility Phone Number: 307 265-3791

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891994950

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	53D2022866
LAB Type	Physician Office
Facility Name	S48WY1 LLC, DBA/WYOMING RECOVERY
Street	231 S WILSON ST
City	CASPER
State	WY
ZIP	82601
Phone	307 265-3791
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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