05D1069845 CLIA NUMBER - SEASHORE EPIPHANY CARE HOMES INC

Laboratory Demographics

CLIA Number: 05D1069845

Facility Name: SEASHORE EPIPHANY CARE HOMES INC

Facility Address:
1260 INDIGO PLACE
OXNARD, CA
ZIP 93030
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Facility Phone Number: 805 983-3845

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1497882591

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	05D1069845
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SEASHORE EPIPHANY CARE HOMES INC
Street	1260 INDIGO PLACE
City	OXNARD
State	CA
ZIP	93030
Phone	805 983-3845
CertificateType	4
CertificateEffectiveDate	6/14/2023
CertificateExpirationDate	6/13/2025
FacilityType	Waiver

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