05D1070880 CLIA NUMBER - BEACHCOMBER HOME

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Field Name	Field Value
CLIA Number	05D1070880
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BEACHCOMBER HOME
Street	3224 WILMOT ST
City	SIMI VALLEY
State	CA
ZIP	93063
Phone	805 581-9302
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/8/2024
Certificate Expiration Date	9/7/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ZIA ABDO MAJID MEMAR

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