03D2168492 CLIA NUMBER - BUENA VISTA

Laboratory Demographics

CLIA Number: 03D2168492

Facility Name: BUENA VISTA

Facility Address:
3033 S ARIZONA AVE
CHANDLER, AZ
ZIP 85286
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Facility Phone Number: 623 256-4184

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1053979724

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	03D2168492
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	BUENA VISTA
Street	3033 S ARIZONA AVE
City	CHANDLER
State	AZ
ZIP	85286
Phone	623 256-4184
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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