03D2148127 CLIA NUMBER - MESA HERITAGE

Laboratory Demographics

CLIA Number: 03D2148127

Facility Name: MESA HERITAGE

Facility Address:
460 N MESA DR, STE 201
MESA, AZ
ZIP 85201
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Facility Phone Number: 480 831-7566

Facility Type: Other - BEHAVIORAL HEALTH OUTPATI

Certificate Type: Waiver

NPI Number: 1124518204

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	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
CertificateType	4
CertificateEffectiveDate	5/3/2024
CertificateExpirationDate	5/2/2026
FacilityType	Waiver

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