05D2070196 CLIA NUMBER - RYLIST INC DBA LAVENTANA TREATMENT PROGRAMS

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Laboratory Demographics

CLIA Number: 05D2070196

Facility Name: RYLIST INC DBA LAVENTANA TREATMENT PROGRAMS

Facility Address:
1408 E THOUSAND OAKS BLVD
THOUSAND OAKS, CA
ZIP 91362
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Facility Phone Number: 818 584-5615

Facility Type: Other - OUTPATIENT SUBS ABUSE FAC

Certificate Type: Waiver

NPI Number: 1407119670

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2070196
LAB Type	Other - OUTPATIENT SUBS ABUSE FAC
Facility Name	RYLIST INC DBA LAVENTANA TREATMENT PROGRAMS
Street	1408 E THOUSAND OAKS BLVD
City	THOUSAND OAKS
State	CA
ZIP	91362
Phone	818 584-5615
CertificateType	4
CertificateEffectiveDate	12/10/2023
CertificateExpirationDate	12/9/2025
FacilityType	Waiver

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