05D2003946 CLIA NUMBER - CACHUELA ICF/ DD-N HOME

Laboratory Demographics

CLIA Code: 05D2003946
Facility Name: CACHUELA ICF/ DD-N HOME
Facility Address: 1721 N GREENGROVE ST
ORANGE, CA
ZIP 92865
Facility Phone: 714 283-4621
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: DILIP C. PATEL
NPI Number: 1376639609
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2003946
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CACHUELA ICF/ DD-N HOME
Street	1721 N GREENGROVE ST
City	ORANGE
State	CA
ZIP	92865
Phone	714 283-4621
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/22/2024
Certificate Expiration Date	2/21/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	DILIP C. PATEL

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