46D2203632 CLIA NUMBER - ODYSSEY HOUSE - FACT

Laboratory Demographics

  • CLIA Code: 46D2203632
  • Facility Name: ODYSSEY HOUSE - FACT
  • Facility Address: 2411 S 1075 W, SUITE A
    WEST VALLEY CITY, UT
    ZIP 84119
  • Facility Phone: 801 322-3222
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DEAN MAYER
  • NPI Number: 1033143706
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2203632
LAB Type Comp. Outpatient Rehab Facility
Facility Name ODYSSEY HOUSE - FACT
Street 2411 S 1075 W, SUITE A
City WEST VALLEY CITY
State UT
ZIP 84119
Phone 801 322-3222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2024
Certificate Expiration Date 12/3/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director DEAN MAYER

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This page was last updated on: 3/20/2025