03D1075748 CLIA NUMBER - LIFEWELL

Laboratory Demographics

CLIA Number: 03D1075748

Facility Name: LIFEWELL

Facility Address:
40 E MITCHELL DR SUITE 100 & 200
PHOENIX, AZ
ZIP 85012
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Facility Phone Number: 602 264-4331

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1689756215

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	03D1075748
LAB Type	Other
Facility Name	LIFEWELL
Street	40 E MITCHELL DR SUITE 100 & 200
City	PHOENIX
State	AZ
ZIP	85012
Phone	602 264-4331
CertificateType	4
CertificateEffectiveDate	10/26/2023
CertificateExpirationDate	10/25/2025
FacilityType	Waiver

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