05D2001293 CLIA NUMBER - HILLSIDE HOUSE

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CLIA Record

Field Name Field Value
CLIA Number 05D2001293
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name HILLSIDE HOUSE
Street 12000 PEACHTREE LANE #1
City YUCAIPA
State CA
ZIP 92399
Phone 909 790-0986
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director SHARON RIESEN

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