05D2056777 CLIA NUMBER - Adolescent Growth, Inc.

Laboratory Demographics

CLIA Number: 05D2056777

Facility Name: Adolescent Growth, Inc.

Facility Address:
5541 Colbath Ave
Sherman Oaks, CA
ZIP 91401
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Facility Phone Number: (888) 549-8884

Facility Type: OTHER

Certificate Type: Waiver

NPI Number: 1578004586

Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children
A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment.

CLIA Record

Field Name Field Value
CLIA Number 05D2056777
Facility Name Adolescent Growth, Inc.
Street 5541 Colbath Ave
City Sherman Oaks
State CA
ZIP 91401
Phone (888) 549-8884

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This page was last updated on: 3/28/2020