05D2126813 CLIA NUMBER - EVOLVE TREATMENT CENTERS - AGOURA

Laboratory Demographics

CLIA Number: 05D2126813

Facility Name: EVOLVE TREATMENT CENTERS - AGOURA

Facility Address:
6425 CHESEBRO DR
AGOURA HILLS, CA
ZIP 91301
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Facility Phone Number: 818 699-6734

Facility Type: Other - RESIDENTIAL TREATMENT CTR

Certificate Type: Waiver

NPI Number: 1154872372

Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	05D2126813
LAB Type	Other - RESIDENTIAL TREATMENT CTR
Facility Name	EVOLVE TREATMENT CENTERS - AGOURA
Street	6425 CHESEBRO DR
City	AGOURA HILLS
State	CA
ZIP	91301
Phone	818 699-6734
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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