05D0894919 CLIA NUMBER - ALPINE SPECIAL TREATMENT CENTER INC

Laboratory Demographics

CLIA Code: 05D0894919
Facility Name: ALPINE SPECIAL TREATMENT CENTER INC
Facility Address: 2120 ALPINE BOULEVARD
ALPINE, CA
ZIP 91901
Facility Phone: 619 445-2644
Facility Type: Skilled Nursing Facility/Nursing Facility
Facility Type: Microscopy
Lab Director: BRIAN MILLER
NPI Number: 1063589620
Taxonomy: 310500000X - Intermediate Care Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D0894919
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	ALPINE SPECIAL TREATMENT CENTER INC
Street	2120 ALPINE BOULEVARD
City	ALPINE
State	CA
ZIP	91901
Phone	619 445-2644
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	11/28/2024
Certificate Expiration Date	11/27/2026
Facility Type	Skilled Nursing Facility/Nursing Facility
Lab Director	BRIAN MILLER

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