46D2148910 CLIA NUMBER - IMPERIAL HEALING ESTATE

Laboratory Demographics

  • CLIA Code: 46D2148910
  • Facility Name: IMPERIAL HEALING ESTATE
  • Facility Address: 4194 N IMPERIAL WAY
    PROVO, UT
    ZIP 84604
  • Facility Phone: 385 312-0352
  • Facility Type: Other - ADOLESCENT RTC
  • Facility Type: Waiver
  • Lab Director: AMY J. WHITTAKER
  • NPI Number: 1033606298
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 46D2148910
LAB Type Other - ADOLESCENT RTC
Facility Name IMPERIAL HEALING ESTATE
Street 4194 N IMPERIAL WAY
City PROVO
State UT
ZIP 84604
Phone 385 312-0352
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Other - ADOLESCENT RTC
Lab Director AMY J. WHITTAKER

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