05D2133360 CLIA NUMBER - RANCHO MILAGRO RECOVERY

Laboratory Demographics

CLIA Number: 05D2133360

Facility Name: RANCHO MILAGRO RECOVERY

Facility Address:
31985 HONEYSUCKLE CIR
WINCHESTER, CA
ZIP 92596
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Facility Phone Number: 951 384-2672

Facility Type: Other - RESIDENTIAL DETOX PROGRAM

Certificate Type: Waiver

NPI Number: 1427418730

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	05D2133360
LAB Type	Other - RESIDENTIAL DETOX PROGRAM
Facility Name	RANCHO MILAGRO RECOVERY
Street	31985 HONEYSUCKLE CIR
City	WINCHESTER
State	CA
ZIP	92596
Phone	951 384-2672
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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