03D2232414 CLIA NUMBER - RISING SUN HEALTHCARE & WELLNESS, LLC

Laboratory Demographics

CLIA Number: 03D2232414

Facility Name: RISING SUN HEALTHCARE & WELLNESS, LLC

Facility Address:
1324 N FARRELL COURT STE 109
GILBERT, AZ
ZIP 85233
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Facility Phone Number: 773 575-4300

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1790456291

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2232414
LAB Type	Practitioner Other
Facility Name	RISING SUN HEALTHCARE & WELLNESS, LLC
Street	1324 N FARRELL COURT STE 109
City	GILBERT
State	AZ
ZIP	85233
Phone	773 575-4300
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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