03D2157689 CLIA NUMBER - EBONY HOUSE, INC - INTEGRATED CARE

Laboratory Demographics

  • CLIA Code: 03D2157689
  • Facility Name: EBONY HOUSE, INC - INTEGRATED CARE
  • Facility Address: 1616 E INDIAN SCHOOL ROAD, SUITE 250
    PHOENIX, AZ
    ZIP 85016
  • Facility Phone: 602 276-4288
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM FREEMAN
  • NPI Number: 1710161419
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 03D2157689
LAB Type Physician Office
Facility Name EBONY HOUSE, INC - INTEGRATED CARE
Street 1616 E INDIAN SCHOOL ROAD, SUITE 250
City PHOENIX
State AZ
ZIP 85016
Phone 602 276-4288
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Physician Office
Lab Director WILLIAM FREEMAN

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