03D2131386 CLIA NUMBER - SCOTTSDALE MODERN DETOX LLC

Laboratory Demographics

  • CLIA Code: 03D2131386
  • Facility Name: SCOTTSDALE MODERN DETOX LLC
  • Facility Address: 7283 E EARLL DR BLDG B
    SCOTTSDALE, AZ
    ZIP 85251
  • Facility Phone: 602 451-6355
  • Facility Type: Other - INPATIENT DETOX
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL VINES
  • NPI Number: 1508296369
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2131386
LAB Type Other - INPATIENT DETOX
Facility Name SCOTTSDALE MODERN DETOX LLC
Street 7283 E EARLL DR BLDG B
City SCOTTSDALE
State AZ
ZIP 85251
Phone 602 451-6355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Other - INPATIENT DETOX
Lab Director DR. MICHAEL VINES

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