46D2130559 CLIA NUMBER - RENAISSANCE RANCH BLUFFDALE - MENS

Laboratory Demographics

CLIA Number: 46D2130559

Facility Name: RENAISSANCE RANCH BLUFFDALE - MENS

Facility Address:
2973 W 13800 S
BLUFFDALE, UT
ZIP 84065
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Facility Phone Number: 801 856-7836

Facility Type: Other - DRUG TESTING

Certificate Type: Waiver

NPI Number: 1780129445

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2130559
LAB Type	Other - DRUG TESTING
Facility Name	RENAISSANCE RANCH BLUFFDALE - MENS
Street	2973 W 13800 S
City	BLUFFDALE
State	UT
ZIP	84065
Phone	801 856-7836
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024