05D2158811 CLIA NUMBER - RESURGENCE CALIFORNIA - PIERCE 1

Laboratory Demographics

CLIA Number: 05D2158811

Facility Name: RESURGENCE CALIFORNIA - PIERCE 1

Facility Address:
3125 PIERCE AVENUE
COSTA MESA, CA
ZIP 92626
Get Directions

Facility Phone Number: 828 773-4477

Facility Type: Other - SUBSTANCE ABUSE

Certificate Type: Waiver

NPI Number: 1942957881

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	05D2158811
LAB Type	Other - SUBSTANCE ABUSE
Facility Name	RESURGENCE CALIFORNIA - PIERCE 1
Street	3125 PIERCE AVENUE
City	COSTA MESA
State	CA
ZIP	92626
Phone	828 773-4477
CertificateType	4
CertificateEffectiveDate	12/6/2022
CertificateExpirationDate	12/5/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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