03D2191671 CLIA NUMBER - DESTINY SOBER LIVING

Laboratory Demographics

  • CLIA Code: 03D2191671
  • Facility Name: DESTINY SOBER LIVING
  • Facility Address: 5306 N 17TH AVE
    PHOENIX, AZ
    ZIP 85015
  • Facility Phone: 602 249-6674
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: KELLY G. BENNETT
  • NPI Number: 1780194563
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2191671
LAB Type Ancillary Testing Site in Health Care Center
Facility Name DESTINY SOBER LIVING
Street 5306 N 17TH AVE
City PHOENIX
State AZ
ZIP 85015
Phone 602 249-6674
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director KELLY G. BENNETT

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