03D2273743 CLIA NUMBER - SCOTTSDALE PROVIDENCE RECOVERY CENTER

Laboratory Demographics

CLIA Number: 03D2273743

Facility Name: SCOTTSDALE PROVIDENCE RECOVERY CENTER

Facility Address:
9389 E VIA DEL SOL DR
SCOTTSDALE, AZ
ZIP 85255
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Facility Phone Number: 480 284-4178

Facility Type: Other - RESIDENTIAL TREATMENT

Certificate Type: Waiver

NPI Number: 1528337896

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	03D2273743
LAB Type	Other - RESIDENTIAL TREATMENT
Facility Name	SCOTTSDALE PROVIDENCE RECOVERY CENTER
Street	9389 E VIA DEL SOL DR
City	SCOTTSDALE
State	AZ
ZIP	85255
Phone	480 284-4178
CertificateType	4
CertificateEffectiveDate	12/19/2022
CertificateExpirationDate	12/18/2024
FacilityType	Waiver

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