03D1051911 CLIA NUMBER - MOUNTAIN VALLEY REGIONAL REHABILITATION HOSPITAL

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Laboratory Demographics

CLIA Number: 03D1051911

Facility Name: MOUNTAIN VALLEY REGIONAL REHABILITATION HOSPITAL

Facility Address:
3700 WINDSONG DRIVE
PRESCOTT VALLEY, AZ
ZIP 86314
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Facility Phone Number: 928 759-8800

Facility Type: Hospital

Certificate Type: Waiver

NPI Number: 1780179044

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1051911
LAB Type	Hospital
Facility Name	MOUNTAIN VALLEY REGIONAL REHABILITATION HOSPITAL
Street	3700 WINDSONG DRIVE
City	PRESCOTT VALLEY
State	AZ
ZIP	86314
Phone	928 759-8800
CertificateType	4
CertificateEffectiveDate	3/14/2024
CertificateExpirationDate	3/13/2026
FacilityType	Waiver

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