03D2214835 CLIA NUMBER - MIRABELLA ASU

Laboratory Demographics

  • CLIA Code: 03D2214835
  • Facility Name: MIRABELLA ASU
  • Facility Address: 65 E UNIVERSITY DR
    TEMPE, AZ
    ZIP 85281
  • Facility Phone: 480 559-2456
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JEREL GOODMAN
  • NPI Number: 1558954552
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2214835
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MIRABELLA ASU
Street 65 E UNIVERSITY DR
City TEMPE
State AZ
ZIP 85281
Phone 480 559-2456
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/25/2025
Certificate Expiration Date 2/24/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JEREL GOODMAN

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