32D2316692 CLIA NUMBER - FOUR CORNERS DETOX RECOVERY CENTER

Laboratory Demographics

  • CLIA Code: 32D2316692
  • Facility Name: FOUR CORNERS DETOX RECOVERY CENTER
  • Facility Address: 2028 E AZTEC
    GALLUP, NM
    ZIP 87301
  • Facility Phone: 505 471-4985
  • Facility Type: Other - DRUG AND ALCOHOL REHAB CE
  • Facility Type: Waiver
  • Lab Director: JAMES BESANTE
  • NPI Number: 1063008761
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 32D2316692
LAB Type Other - DRUG AND ALCOHOL REHAB CE
Facility Name FOUR CORNERS DETOX RECOVERY CENTER
Street 2028 E AZTEC
City GALLUP
State NM
ZIP 87301
Phone 505 471-4985
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Other - DRUG AND ALCOHOL REHAB CE
Lab Director JAMES BESANTE

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