05D2153187 CLIA NUMBER - BOARDWALK RECOVERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2153187
  • Facility Name: BOARDWALK RECOVERY CENTER
  • Facility Address: 1940 GARNET AVE STE 120
    SAN DIEGO, CA
    ZIP 92109
  • Facility Phone: 858 888-0101
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: JOHN W. ALLEN
  • NPI Number: 1639677768
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2153187
LAB Type Comp. Outpatient Rehab Facility
Facility Name BOARDWALK RECOVERY CENTER
Street 1940 GARNET AVE STE 120
City SAN DIEGO
State CA
ZIP 92109
Phone 858 888-0101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director JOHN W. ALLEN

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