03D2197410 CLIA NUMBER - GRANITE GATE SENIOR LIVING

Laboratory Demographics

  • CLIA Code: 03D2197410
  • Facility Name: GRANITE GATE SENIOR LIVING
  • Facility Address: 3850 N US HIGWAY 89
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 771-8200
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JOSEPH TYTLER
  • NPI Number: 1811191943
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2197410
LAB Type Assisted Living Facility
Facility Name GRANITE GATE SENIOR LIVING
Street 3850 N US HIGWAY 89
City PRESCOTT
State AZ
ZIP 86301
Phone 928 771-8200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Assisted Living Facility
Lab Director JOSEPH TYTLER

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