03D1101539 CLIA NUMBER - HERITAGE LANE BEHAVIORAL ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 03D1101539
  • Facility Name: HERITAGE LANE BEHAVIORAL ASSISTED LIVING
  • Facility Address: 1040 SOUTH LEBARON ST
    MESA, AZ
    ZIP 85210
  • Facility Phone: 480 307-8809
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: REED GUNNELL
  • NPI Number: 1144452988
  • Taxonomy: 3104A0625X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D1101539
LAB Type Assisted Living Facility
Facility Name HERITAGE LANE BEHAVIORAL ASSISTED LIVING
Street 1040 SOUTH LEBARON ST
City MESA
State AZ
ZIP 85210
Phone 480 307-8809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Assisted Living Facility
Lab Director REED GUNNELL

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