03D0057458 CLIA NUMBER - EVERNORTH CARE GROUP-CHANDLER

Laboratory Demographics

CLIA Number: 03D0057458

Facility Name: EVERNORTH CARE GROUP-CHANDLER

Facility Address:
1717 W CHANDLER BLVD
CHANDLER, AZ
ZIP 85224
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Facility Phone Number: 480 821-7565

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1467531681

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	03D0057458
LAB Type	Community Clinic
Facility Name	EVERNORTH CARE GROUP-CHANDLER
Street	1717 W CHANDLER BLVD
City	CHANDLER
State	AZ
ZIP	85224
Phone	480 821-7565
CertificateType	4
CertificateEffectiveDate	4/18/2023
CertificateExpirationDate	4/17/2025
FacilityType	Waiver

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