03D0969083 CLIA NUMBER - YOUTH DEVELOPMENT INSTITUTE

Laboratory Demographics

CLIA Number: 03D0969083

Facility Name: YOUTH DEVELOPMENT INSTITUTE

Facility Address:
1830 E ROOSEVELT ST
PHOENIX, AZ
ZIP 85006
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Facility Phone Number: 602 254-0884

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1508939554

Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	03D0969083
LAB Type	Other
Facility Name	YOUTH DEVELOPMENT INSTITUTE
Street	1830 E ROOSEVELT ST
City	PHOENIX
State	AZ
ZIP	85006
Phone	602 254-0884
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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