05D2110188 CLIA NUMBER - AVENIDA LIVING HOME INC.

Laboratory Demographics

CLIA Number: 05D2110188

Facility Name: AVENIDA LIVING HOME INC.

Facility Address:
2465 AVENIDA DE LAS PLANTAS
THOUSAND OAKS, CA
ZIP 91360
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Facility Phone Number: 805 557-0010

Facility Type: Other - CONG LVN HLTH FAC TY C

Certificate Type: Waiver

NPI Number: 1619336740

Taxonomy: 320700000X - Residential Treatment Facility, Physical Disabilities
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	05D2110188
LAB Type	Other - CONG LVN HLTH FAC TY C
Facility Name	AVENIDA LIVING HOME INC.
Street	2465 AVENIDA DE LAS PLANTAS
City	THOUSAND OAKS
State	CA
ZIP	91360
Phone	805 557-0010
CertificateType	4
CertificateEffectiveDate	3/10/2024
CertificateExpirationDate	3/9/2026
FacilityType	Waiver

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