05D2099508 CLIA NUMBER - TRES VISTAS OUTPATIENT CENTER

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Laboratory Demographics

CLIA Number: 05D2099508

Facility Name: TRES VISTAS OUTPATIENT CENTER

Facility Address:
32301 CAMINO CAPISTRANO, STE K
SAN JUAN CAPISTRANO, CA
ZIP 92675
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Facility Phone Number: 844 900-0444

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1528446044

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	05D2099508
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	TRES VISTAS OUTPATIENT CENTER
Street	32301 CAMINO CAPISTRANO, STE K
City	SAN JUAN CAPISTRANO
State	CA
ZIP	92675
Phone	844 900-0444
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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