03D2285971 CLIA NUMBER - MOGOLLON TREATMENT CENTER DBA PARADISE VALLEY RECOVERY

Laboratory Demographics

CLIA Number: 03D2285971

Facility Name: MOGOLLON TREATMENT CENTER DBA PARADISE VALLEY RECOVERY

Facility Address:
5402 E THOMAS RD
PHOENIX, AZ
ZIP 85018
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Facility Phone Number: 602 675-0460

Facility Type: Other - TREATMENT CENTER

Certificate Type: Waiver

NPI Number: 1750160511

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	03D2285971
LAB Type	Other - TREATMENT CENTER
Facility Name	MOGOLLON TREATMENT CENTER DBA PARADISE VALLEY RECOVERY
Street	5402 E THOMAS RD
City	PHOENIX
State	AZ
ZIP	85018
Phone	602 675-0460
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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