05D1068073 CLIA NUMBER - BETTY FORD CENTER RANCHO MIRAGE

Laboratory Demographics

  • CLIA Code: 05D1068073
  • Facility Name: BETTY FORD CENTER RANCHO MIRAGE
  • Facility Address: 39407 VISTA DEL SOL
    RANCHO MIRAGE, CA
    ZIP 92270
  • Facility Phone: 760 837-8733
  • Facility Type: Other - OUTPATIENT SUBSTANCE
  • Facility Type: Waiver
  • Lab Director: ALTA L. DEROO
  • NPI Number: 1386324945
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D1068073
LAB Type Other - OUTPATIENT SUBSTANCE
Facility Name BETTY FORD CENTER RANCHO MIRAGE
Street 39407 VISTA DEL SOL
City RANCHO MIRAGE
State CA
ZIP 92270
Phone 760 837-8733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Other - OUTPATIENT SUBSTANCE
Lab Director ALTA L. DEROO

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