05D1038424 CLIA NUMBER - CROSSROADS OF CHOICE, INC

Laboratory Demographics

CLIA Number: 05D1038424

Facility Name: CROSSROADS OF CHOICE, INC

Facility Address:
11130 WHITE BIRCH DR
RANCHO CUCAMONGA, CA
ZIP 91730
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Facility Phone Number: 909 484-5561

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1770108136

Taxonomy: 343900000X - Non-emergency Medical Transport (VAN)
A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations.

CLIA Record

Field Name	Field Value
CLIA Number	05D1038424
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CROSSROADS OF CHOICE, INC
Street	11130 WHITE BIRCH DR
City	RANCHO CUCAMONGA
State	CA
ZIP	91730
Phone	909 484-5561
CertificateType	4
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Waiver

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