03D2124795 CLIA NUMBER - SURPRISE ALC LLC DBA VINEYARD PARK OF SURPRISE

Laboratory Demographics

  • CLIA Code: 03D2124795
  • Facility Name: SURPRISE ALC LLC DBA VINEYARD PARK OF SURPRISE
  • Facility Address: 16650 N STADIUM WAY
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 561-7728
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MARIA ORDAZ
  • NPI Number: 1700835303
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 03D2124795
LAB Type Assisted Living Facility
Facility Name SURPRISE ALC LLC DBA VINEYARD PARK OF SURPRISE
Street 16650 N STADIUM WAY
City SURPRISE
State AZ
ZIP 85374
Phone 623 561-7728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Assisted Living Facility
Lab Director MARIA ORDAZ

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