05D2150077 CLIA NUMBER - EVOLVE TREATMENT CENTERS - LOCATION 3 AZUCENA

Laboratory Demographics

CLIA Code: 05D2150077
Facility Name: EVOLVE TREATMENT CENTERS - LOCATION 3 AZUCENA
Facility Address: 4810 AZUCENA RD
WOODLAND HILLS, CA
ZIP 91364
Facility Phone: 818 444-6980
Facility Type: Other - RESID TRTMENT CENTER
Facility Type: Waiver
Lab Director: MELISSA VALLAS
NPI Number: 1356793947
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2150077
LAB Type	Other - RESID TRTMENT CENTER
Facility Name	EVOLVE TREATMENT CENTERS - LOCATION 3 AZUCENA
Street	4810 AZUCENA RD
City	WOODLAND HILLS
State	CA
ZIP	91364
Phone	818 444-6980
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/15/2024
Certificate Expiration Date	6/14/2026
Facility Type	Other - RESID TRTMENT CENTER
Lab Director	MELISSA VALLAS

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This page was last updated on: 9/29/2025