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03D2170131 CLIA NUMBER - STONEWALL INSTITUTE TREATMENT CENTER

Laboratory Demographics

CLIA Number: 03D2170131

Facility Name: STONEWALL INSTITUTE TREATMENT CENTER

Facility Address:
4020 N 20TH STREET SUITE 302
PHOENIX, AZ
ZIP 85016
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Facility Phone Number: 602 535-6468

Facility Type: Other - OTC

Certificate Type: Waiver
NPI Number: 1972838167

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 03D2170131
LAB Type Other - OTC
Facility Name STONEWALL INSTITUTE TREATMENT CENTER
Street 4020 N 20TH STREET SUITE 302
City PHOENIX
State AZ
ZIP 85016
Phone 602 535-6468
CertificateType 4
CertificateEffectiveDate 8/2/2023
CertificateExpirationDate 8/1/2025
FacilityType Waiver

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