03D2105177 CLIA NUMBER - ANASAZI FOUNDATION

Laboratory Demographics

  • CLIA Code: 03D2105177
  • Facility Name: ANASAZI FOUNDATION
  • Facility Address: 1424 S STAPLEY DR
    MESA, AZ
    ZIP 85204
  • Facility Phone: 408 892-7403
  • Facility Type: Other - RESIDENTIAL TREATMENT
  • Facility Type: Waiver
  • Lab Director: MICHAEL MERCHANT
  • NPI Number: 1497833644
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2105177
LAB Type Other - RESIDENTIAL TREATMENT
Facility Name ANASAZI FOUNDATION
Street 1424 S STAPLEY DR
City MESA
State AZ
ZIP 85204
Phone 408 892-7403
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Other - RESIDENTIAL TREATMENT
Lab Director MICHAEL MERCHANT

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This page was last updated on: 6/4/2025