05D2159910 CLIA NUMBER - CROSSROAD TRANSITIONAL INC

Laboratory Demographics

  • CLIA Code: 05D2159910
  • Facility Name: CROSSROAD TRANSITIONAL INC
  • Facility Address: 19646 BALLINGER STREET
    NORTHRIDGE, CA
    ZIP 91324
  • Facility Phone: 818 918-7223
  • Facility Type: Public Health Laboratories
  • Facility Type: Waiver
  • Lab Director: FAWSY BASTA
  • NPI Number: 1245684216
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2159910
LAB Type Public Health Laboratories
Facility Name CROSSROAD TRANSITIONAL INC
Street 19646 BALLINGER STREET
City NORTHRIDGE
State CA
ZIP 91324
Phone 818 918-7223
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/31/2024
Certificate Expiration Date 12/30/2026
Facility Type Public Health Laboratories
Lab Director FAWSY BASTA

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