05D2098568 CLIA NUMBER - WESTSIDE TREATMENT, LLC

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Laboratory Demographics

CLIA Number: 05D2098568

Facility Name: WESTSIDE TREATMENT, LLC

Facility Address:
11150 W OLYMPIC BLVD STE 760
LOS ANGELES, CA
ZIP 90064
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Facility Phone Number: 424 835-6507

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1093129306

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2098568
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	WESTSIDE TREATMENT, LLC
Street	11150 W OLYMPIC BLVD STE 760
City	LOS ANGELES
State	CA
ZIP	90064
Phone	424 835-6507
CertificateType	4
CertificateEffectiveDate	7/9/2023
CertificateExpirationDate	7/8/2025
FacilityType	Waiver

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