05D2157645 CLIA NUMBER - PACIFIC RECOVERY SOLUTIONS

Laboratory Demographics

CLIA Number: 05D2157645

Facility Name: PACIFIC RECOVERY SOLUTIONS

Facility Address:
7966 BEVERLY BLVD
LOS ANGELES, CA
ZIP 90048
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Facility Phone Number: 918 804-7684

Facility Type: Other - OUTPATIENT TREATMENT

Certificate Type: Waiver

NPI Number: 1215412879

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2157645
LAB Type	Other - OUTPATIENT TREATMENT
Facility Name	PACIFIC RECOVERY SOLUTIONS
Street	7966 BEVERLY BLVD
City	LOS ANGELES
State	CA
ZIP	90048
Phone	918 804-7684
CertificateType	4
CertificateEffectiveDate	11/8/2022
CertificateExpirationDate	11/7/2024
FacilityType	Waiver

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