03D1030139 CLIA NUMBER - LAKE MOHAVE RANCHO FIRE

Laboratory Demographics

CLIA Number: 03D1030139

Facility Name: LAKE MOHAVE RANCHO FIRE

Facility Address:
16126 PEARCE FERRY ROAD
DOLAN SPRINGS, AZ
ZIP 86441
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Facility Phone Number: 928 767-3300

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1861420929

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	03D1030139
LAB Type	Ambulance
Facility Name	LAKE MOHAVE RANCHO FIRE
Street	16126 PEARCE FERRY ROAD
City	DOLAN SPRINGS
State	AZ
ZIP	86441
Phone	928 767-3300
CertificateType	4
CertificateEffectiveDate	8/31/2022
CertificateExpirationDate	8/30/2024
FacilityType	Waiver

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