03D2319779 CLIA NUMBER - IDEAL TREATMENT CENTER LLC

Laboratory Demographics

  • CLIA Code: 03D2319779
  • Facility Name: IDEAL TREATMENT CENTER LLC
  • Facility Address: 1717 W NORTHERN AVE STE 107
    PHOENIX, AZ
    ZIP 85021
  • Facility Phone: 602 800-9056
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: AIMEE UWIMANA
  • NPI Number: 1336837616
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2319779
LAB Type Comp. Outpatient Rehab Facility
Facility Name IDEAL TREATMENT CENTER LLC
Street 1717 W NORTHERN AVE STE 107
City PHOENIX
State AZ
ZIP 85021
Phone 602 800-9056
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director AIMEE UWIMANA

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