03D2063142 CLIA NUMBER - PRESCOTT HOUSE INC

Laboratory Demographics

  • CLIA Code: 03D2063142
  • Facility Name: PRESCOTT HOUSE INC
  • Facility Address: 214 N ARIZONA AVE, BLDG B, STE D
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 533-1789
  • Facility Type: Other - RECOVERY CENTER
  • Facility Type: Waiver
  • Lab Director: TIMOTHY SCANLAN
  • NPI Number: 1932540119
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 03D2063142
LAB Type Other - RECOVERY CENTER
Facility Name PRESCOTT HOUSE INC
Street 214 N ARIZONA AVE, BLDG B, STE D
City PRESCOTT
State AZ
ZIP 86301
Phone 928 533-1789
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2025
Certificate Expiration Date 7/25/2027
Facility Type Other - RECOVERY CENTER
Lab Director TIMOTHY SCANLAN

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