05D2123912 CLIA NUMBER - SOUTH COAST BEHAVIORAL HEALTH

Laboratory Demographics

CLIA Number: 05D2123912

Facility Name: SOUTH COAST BEHAVIORAL HEALTH

Facility Address:
559 PIERPONT DR
COSTA MESA, CA
ZIP 92626
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Facility Phone Number: 714 556-2112

Facility Type: Other - DTX/RES-SUD TREATMENT

Certificate Type: Waiver

NPI Number: 1184950073

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2123912
LAB Type	Other - DTX/RES-SUD TREATMENT
Facility Name	SOUTH COAST BEHAVIORAL HEALTH
Street	559 PIERPONT DR
City	COSTA MESA
State	CA
ZIP	92626
Phone	714 556-2112
CertificateType	4
CertificateEffectiveDate	4/22/2023
CertificateExpirationDate	4/21/2025
FacilityType	Waiver

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