36D2323409 CLIA NUMBER - PHOENIX GROUP HOME LLC

Laboratory Demographics

  • CLIA Code: 36D2323409
  • Facility Name: PHOENIX GROUP HOME LLC
  • Facility Address: 151 S KENNEBEC AVENUE
    MCCONNELSVILLE, OH
    ZIP 43756
  • Facility Phone: 740 960-0568
  • Facility Type: Other - MENTAL HEALTH
  • Facility Type: Waiver
  • Lab Director: CHERYL BAILEY-SALARY
  • NPI Number: 1083146013
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 36D2323409
LAB Type Other - MENTAL HEALTH
Facility Name PHOENIX GROUP HOME LLC
Street 151 S KENNEBEC AVENUE
City MCCONNELSVILLE
State OH
ZIP 43756
Phone 740 960-0568
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Other - MENTAL HEALTH
Lab Director CHERYL BAILEY-SALARY

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