05D2153187 CLIA NUMBER - BOARDWALK RECOVERY CENTER

Laboratory Demographics

CLIA Number: 05D2153187

Facility Name: BOARDWALK RECOVERY CENTER

Facility Address:
1940 GARNET AVE STE 120
SAN DIEGO, CA
ZIP 92109
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Facility Phone Number: 858 888-0101

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1639677768

Taxonomy: 261QR0405X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	8/23/2022
CertificateExpirationDate	8/22/2024
FacilityType	Waiver

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