03D2095159 CLIA NUMBER - SEAGLASS AZ LLC

Laboratory Demographics

  • CLIA Code: 03D2095159
  • Facility Name: SEAGLASS AZ LLC
  • Facility Address: 709 W GURLEY ST
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 561 562-6269
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: LISA A. TOMSAK
  • NPI Number: 1003372491
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2095159
LAB Type Comp. Outpatient Rehab Facility
Facility Name SEAGLASS AZ LLC
Street 709 W GURLEY ST
City PRESCOTT
State AZ
ZIP 86305
Phone 561 562-6269
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2025
Certificate Expiration Date 4/30/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director LISA A. TOMSAK

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