03D2131536 CLIA NUMBER - PRONGHORN PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 03D2131536
  • Facility Name: PRONGHORN PSYCHIATRY
  • Facility Address: 5940 E COPPER HILL DRIVE STE B
    PRESCOTT VALLEY, AZ
    ZIP 86314
  • Facility Phone: 928 583-7799
  • Facility Type: Other - INPATIENT ACUTE PSYCH HOS
  • Facility Type: Waiver
  • Lab Director: MARK COLLINS
  • NPI Number: 1922401496
  • Taxonomy: 283Q00000X - Psychiatric Hospital

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2131536
LAB Type Other - INPATIENT ACUTE PSYCH HOS
Facility Name PRONGHORN PSYCHIATRY
Street 5940 E COPPER HILL DRIVE STE B
City PRESCOTT VALLEY
State AZ
ZIP 86314
Phone 928 583-7799
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2025
Certificate Expiration Date 5/30/2027
Facility Type Other - INPATIENT ACUTE PSYCH HOS
Lab Director MARK COLLINS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025