03D2119688 CLIA NUMBER - WHITETANK MOUNTAIN HEALTHCARE LLC

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Laboratory Demographics

CLIA Number: 03D2119688

Facility Name: WHITETANK MOUNTAIN HEALTHCARE LLC

Facility Address:
10320 W MCDOWELL RD, BLDG G, STE 7024-B
AVONDALE, AZ
ZIP 85392
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Facility Phone Number: (623) 322-8686

Facility Type: HOSPICE

Certificate Type: Waiver

NPI Number: 1164054136

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	03D2119688
LAB Type	HOSPICE
Facility Name	WHITETANK MOUNTAIN HEALTHCARE LLC
Street	10320 W MCDOWELL RD, BLDG G, STE 7024-B
City	AVONDALE
State	AZ
ZIP	85392
Phone	(623) 322-8686

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This page was last updated on: 5/11/2023