13D2323732 CLIA NUMBER - PHILLIPS RANCH LLC

Laboratory Demographics

  • CLIA Code: 13D2323732
  • Facility Name: PHILLIPS RANCH LLC
  • Facility Address: 3067 MOSQUITO CREEK RD
    CLARK FORK, ID
    ZIP 83811
  • Facility Phone: 720 490-0550
  • Facility Type: Other - RESIDENTAL BEHAVIORIAL
  • Facility Type: Waiver
  • Lab Director: ALISON G. AGGEN
  • NPI Number: 1881424224
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2323732
LAB Type Other - RESIDENTAL BEHAVIORIAL
Facility Name PHILLIPS RANCH LLC
Street 3067 MOSQUITO CREEK RD
City CLARK FORK
State ID
ZIP 83811
Phone 720 490-0550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Other - RESIDENTAL BEHAVIORIAL
Lab Director ALISON G. AGGEN

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