05D2119375 CLIA NUMBER - PACIFIC PALMS RECOVERY LLC

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Laboratory Demographics

CLIA Number: 05D2119375

Facility Name: PACIFIC PALMS RECOVERY LLC

Facility Address:
2215 MESA DR
OCEANSIDE, CA
ZIP 92054
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Facility Phone Number: 619 807-3173

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1013456342

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	05D2119375
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	PACIFIC PALMS RECOVERY LLC
Street	2215 MESA DR
City	OCEANSIDE
State	CA
ZIP	92054
Phone	619 807-3173
CertificateType	4
CertificateEffectiveDate	9/26/2022
CertificateExpirationDate	9/25/2024
FacilityType	Waiver

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