03D2198823 CLIA NUMBER - HOLBROOK HIGH SCHOOL

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Laboratory Demographics

CLIA Number: 03D2198823

Facility Name: HOLBROOK HIGH SCHOOL

Facility Address:
455 S 8TH AVE
HOLBROOK, AZ
ZIP 86025
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Facility Phone Number: 928 524-2815

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1760933154

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	03D2198823
LAB Type	School/Student Health Service
Facility Name	HOLBROOK HIGH SCHOOL
Street	455 S 8TH AVE
City	HOLBROOK
State	AZ
ZIP	86025
Phone	928 524-2815
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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