05D2041330 CLIA NUMBER - BROWN HOUSE VILLA ESTERANZA SERVICES

Laboratory Demographics

CLIA Code: 05D2041330
Facility Name: BROWN HOUSE VILLA ESTERANZA SERVICES
Facility Address: 427 N CRAIG AVE
PASADENA, CA
ZIP 91107
Facility Phone: 626 449-2919
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: ROY H. JACKSON
NPI Number: 1831305564
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2041330
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BROWN HOUSE VILLA ESTERANZA SERVICES
Street	427 N CRAIG AVE
City	PASADENA
State	CA
ZIP	91107
Phone	626 449-2919
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	5/21/2024
Certificate Expiration Date	5/20/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ROY H. JACKSON

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