03D2318620 CLIA NUMBER - MARICOPA REENTRY CENTER

Laboratory Demographics

  • CLIA Code: 03D2318620
  • Facility Name: MARICOPA REENTRY CENTER
  • Facility Address: 24601 N 29TH AVE
    PHOENIX, AZ
    ZIP 85027
  • Facility Phone: 490 998-4673
  • Facility Type: Other - MARICOPA REENTRY CENTER
  • Facility Type: Waiver
  • Lab Director: RANDY S. GELOW
  • NPI Number: 1265031108
  • Taxonomy: 363AS0400X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 03D2318620
LAB Type Other - MARICOPA REENTRY CENTER
Facility Name MARICOPA REENTRY CENTER
Street 24601 N 29TH AVE
City PHOENIX
State AZ
ZIP 85027
Phone 490 998-4673
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2025
Certificate Expiration Date 2/13/2027
Facility Type Other - MARICOPA REENTRY CENTER
Lab Director RANDY S. GELOW

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