03D2199487 CLIA NUMBER - DEVEREUX ARIZONA - COMMUNITY AND FAMILY SERVICES

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Laboratory Demographics

CLIA Number: 03D2199487

Facility Name: DEVEREUX ARIZONA - COMMUNITY AND FAMILY SERVICES

Facility Address:
11024 N 28TH DR STE 110
PHOENIX, AZ
ZIP 85029
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Facility Phone Number: 602 283-1573

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1255983037

Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	03D2199487
LAB Type	Community Clinic
Facility Name	DEVEREUX ARIZONA - COMMUNITY AND FAMILY SERVICES
Street	11024 N 28TH DR STE 110
City	PHOENIX
State	AZ
ZIP	85029
Phone	602 283-1573
CertificateType	4
CertificateEffectiveDate	11/9/2022
CertificateExpirationDate	11/8/2024
FacilityType	Waiver

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