05D1069852 CLIA NUMBER - PELICAN HOME EPIPHANY CARE HOMES INC

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Field Name	Field Value
CLIA Number	05D1069852
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PELICAN HOME EPIPHANY CARE HOMES INC
Street	1101 IVYWOOD DR
City	OXNARD
State	CA
ZIP	93030
Phone	805 983-7601
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/23/2024
Certificate Expiration Date	1/22/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ABDO MEMAR-ZIA

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