03D2148127 CLIA NUMBER - MESA HERITAGE

Laboratory Demographics

  • CLIA Code: 03D2148127
  • Facility Name: MESA HERITAGE
  • Facility Address: 460 N MESA DR, STE 201
    MESA, AZ
    ZIP 85201
  • Facility Phone: 480 831-7566
  • Facility Type: Other - BEHAVIORAL HEALTH OUTPATI
  • Facility Type: Waiver
  • Lab Director: EMILY KOCH
  • NPI Number: 1124518204
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 03D2148127
LAB Type Other - BEHAVIORAL HEALTH OUTPATI
Facility Name MESA HERITAGE
Street 460 N MESA DR, STE 201
City MESA
State AZ
ZIP 85201
Phone 480 831-7566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Other - BEHAVIORAL HEALTH OUTPATI
Lab Director EMILY KOCH

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