05D0913069 CLIA NUMBER - DEVELOPMENTAL CLIENT CARE/DDH FACILITY

Laboratory Demographics

CLIA Code: 05D0913069
Facility Name: DEVELOPMENTAL CLIENT CARE/DDH FACILITY
Facility Address: 24576 ORMISTA DRIVE
MORENO VALLEY, CA
ZIP 92553
Facility Phone: 909 242-3171
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: CARL E. ROWE
NPI Number: 1356490346
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D0913069
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	DEVELOPMENTAL CLIENT CARE/DDH FACILITY
Street	24576 ORMISTA DRIVE
City	MORENO VALLEY
State	CA
ZIP	92553
Phone	909 242-3171
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/20/2024
Certificate Expiration Date	3/19/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	CARL E. ROWE

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