03D0975707 CLIA NUMBER - IMMANUEL MANOR

Laboratory Demographics

  • CLIA Code: 03D0975707
  • Facility Name: IMMANUEL MANOR
  • Facility Address: 11311 N 99TH AVENUE
    PEORIA, AZ
    ZIP 85345
  • Facility Phone: 623 876-6100
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: KAYLA STUMBO
  • NPI Number: 1265439889
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D0975707
LAB Type Other
Facility Name IMMANUEL MANOR
Street 11311 N 99TH AVENUE
City PEORIA
State AZ
ZIP 85345
Phone 623 876-6100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Other
Lab Director KAYLA STUMBO

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