03D2204440 CLIA NUMBER - TUCSON RESIDENCE FOUNDATION

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Laboratory Demographics

CLIA Number: 03D2204440

Facility Name: TUCSON RESIDENCE FOUNDATION

Facility Address:
115 S SHERWOOD VILLAGE DR
TUCSON, AZ
ZIP 85710
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Facility Phone Number: 520 790-9144

Facility Type: Other - LTCF

Certificate Type: Waiver

NPI Number: 1669041240

Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	03D2204440
LAB Type	Other - LTCF
Facility Name	TUCSON RESIDENCE FOUNDATION
Street	115 S SHERWOOD VILLAGE DR
City	TUCSON
State	AZ
ZIP	85710
Phone	520 790-9144
CertificateType	4
CertificateEffectiveDate	12/9/2022
CertificateExpirationDate	12/8/2024
FacilityType	Waiver

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