05D2134236 CLIA NUMBER - RESTORE HEALTH AND WELLNESS CENTER LLC

Laboratory Demographics

CLIA Number: 05D2134236

Facility Name: RESTORE HEALTH AND WELLNESS CENTER LLC

Facility Address:
10342 DESOTO AVE
CHATSWORTH, CA
ZIP 91311
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Facility Phone Number: 818 806-3179

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1790332799

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	05D2134236
LAB Type	Independent
Facility Name	RESTORE HEALTH AND WELLNESS CENTER LLC
Street	10342 DESOTO AVE
City	CHATSWORTH
State	CA
ZIP	91311
Phone	818 806-3179
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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