05D2051708 CLIA NUMBER - BRIDGE 2 LIFE-ADDISON, LLC

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Laboratory Demographics

CLIA Number: 05D2051708

Facility Name: BRIDGE 2 LIFE-ADDISON, LLC

Facility Address:
1331 ADDISON WAY
PERRIS, CA
ZIP 92571
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Facility Phone Number: 951 928-0494

Facility Type: Other - CONGREGATE LIVING HEALTH

Certificate Type: Waiver

NPI Number: 1427348424

Taxonomy: 3140N1450X - Skilled Nursing Facility
A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.

CLIA Record

Field Name	Field Value
CLIA Number	05D2051708
LAB Type	Other - CONGREGATE LIVING HEALTH
Facility Name	BRIDGE 2 LIFE-ADDISON, LLC
Street	1331 ADDISON WAY
City	PERRIS
State	CA
ZIP	92571
Phone	951 928-0494
CertificateType	4
CertificateEffectiveDate	12/26/2022
CertificateExpirationDate	12/25/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024