03D2126962 CLIA NUMBER - CLEANSLATE CENTERS

Laboratory Demographics

CLIA Number: 03D2126962

Facility Name: CLEANSLATE CENTERS

Facility Address:
8410 W THOMAS RD STE 124
PHOENIX, AZ
ZIP 85037
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Facility Phone Number: (413) 584-2173

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1194264911

Taxonomy: 207RA0401X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

CLIA Record

Field Name	Field Value
CLIA Number	03D2126962
LAB Type	PHYSICIAN OFFICE
Facility Name	CLEANSLATE CENTERS
Street	8410 W THOMAS RD STE 124
City	PHOENIX
State	AZ
ZIP	85037
Phone	(413) 584-2173

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