05D2091554 CLIA NUMBER - PILLARS RECOVERY

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Laboratory Demographics

CLIA Number: 05D2091554

Facility Name: PILLARS RECOVERY

Facility Address:
304 MARGAURITE AVE
CORONA DEL MAR, CA
ZIP 92625
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Facility Phone Number: 949 514-5838

Facility Type: Other - TRTMNT RESID DETOX

Certificate Type: Waiver

NPI Number: 1861051799

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2091554
LAB Type	Other - TRTMNT RESID DETOX
Facility Name	PILLARS RECOVERY
Street	304 MARGAURITE AVE
City	CORONA DEL MAR
State	CA
ZIP	92625
Phone	949 514-5838
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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