02D2290822 CLIA NUMBER - FOOTHILLS BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 02D2290822
  • Facility Name: FOOTHILLS BEHAVIORAL HEALTH
  • Facility Address: 16635 CENTERFIELD DR, 3204
    EAGLE RIVER, AK
    ZIP 99577
  • Facility Phone: 907 694-2300
  • Facility Type: Other - PMHNP-BC
  • Facility Type: Waiver
  • Lab Director: JASON T. MARTIN
  • NPI Number: 1992461420
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 02D2290822
LAB Type Other - PMHNP-BC
Facility Name FOOTHILLS BEHAVIORAL HEALTH
Street 16635 CENTERFIELD DR, 3204
City EAGLE RIVER
State AK
ZIP 99577
Phone 907 694-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2023
Certificate Expiration Date 10/1/2025
Facility Type Other - PMHNP-BC
Lab Director JASON T. MARTIN

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