03D2075031 CLIA NUMBER - MOUNTAIN PARK SENIOR LIVING

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Laboratory Demographics

CLIA Number: 03D2075031

Facility Name: MOUNTAIN PARK SENIOR LIVING

Facility Address:
4475 EAST KNOX RD
PHOENIX, AZ
ZIP 85044
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Facility Phone Number: 480 893-1200

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1457719114

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	03D2075031
LAB Type	Assisted Living Facility
Facility Name	MOUNTAIN PARK SENIOR LIVING
Street	4475 EAST KNOX RD
City	PHOENIX
State	AZ
ZIP	85044
Phone	480 893-1200
CertificateType	4
CertificateEffectiveDate	3/20/2024
CertificateExpirationDate	3/19/2026
FacilityType	Waiver

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