05D2068130 CLIA NUMBER - BARN LIFE, LLC

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Laboratory Demographics

CLIA Number: 05D2068130

Facility Name: BARN LIFE, LLC

Facility Address:
126 E 16TH ST
COSTA MESA, CA
ZIP 92627
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Facility Phone Number: 949 229-6853

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1083180095

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	05D2068130
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	BARN LIFE, LLC
Street	126 E 16TH ST
City	COSTA MESA
State	CA
ZIP	92627
Phone	949 229-6853
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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