05D2083201 CLIA NUMBER - AUTHENTIC RECOVERY LLC

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Laboratory Demographics

CLIA Number: 05D2083201

Facility Name: AUTHENTIC RECOVERY LLC

Facility Address:
2203 OVERLAND AVE
LOS ANGELES, CA
ZIP 90064
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Facility Phone Number: 714 988-4381

Facility Type: Other - RESIDENTIAL DRUG & ALCOHO

Certificate Type: Waiver

NPI Number: 1144971813

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	05D2083201
LAB Type	Other - RESIDENTIAL DRUG & ALCOHO
Facility Name	AUTHENTIC RECOVERY LLC
Street	2203 OVERLAND AVE
City	LOS ANGELES
State	CA
ZIP	90064
Phone	714 988-4381
CertificateType	4
CertificateEffectiveDate	8/29/2022
CertificateExpirationDate	8/28/2024
FacilityType	Waiver

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