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03D2133560 CLIA NUMBER - DESTINY OUTPATIENT SERVICES

Laboratory Demographics

CLIA Number: 03D2133560

Facility Name: DESTINY OUTPATIENT SERVICES

Facility Address:
5308 N 17TH AVE
PHOENIX, AZ
ZIP 85015
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Facility Phone Number: 602 249-6674

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver
NPI Number: 1336593045

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name Field Value
CLIA Number 03D2133560
LAB Type Ancillary Testing Site in Health Care Center
Facility Name DESTINY OUTPATIENT SERVICES
Street 5308 N 17TH AVE
City PHOENIX
State AZ
ZIP 85015
Phone 602 249-6674
CertificateType 4
CertificateEffectiveDate 8/31/2022
CertificateExpirationDate 8/30/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024