05D2169060 CLIA NUMBER - RENEWAL HEALTH GROUP DBA THE LAKE 2

Laboratory Demographics

  • CLIA Code: 05D2169060
  • Facility Name: RENEWAL HEALTH GROUP DBA THE LAKE 2
  • Facility Address: 4755 AMIGO AVENUE
    TARZANA, CA
    ZIP 91356
  • Facility Phone: 805 302-3651
  • Facility Type: Other - BEHAVIORAL HEALTH REHAB
  • Facility Type: Waiver
  • Lab Director: NEDA JAVAHERIAN
  • NPI Number: 1972169605
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2169060
LAB Type Other - BEHAVIORAL HEALTH REHAB
Facility Name RENEWAL HEALTH GROUP DBA THE LAKE 2
Street 4755 AMIGO AVENUE
City TARZANA
State CA
ZIP 91356
Phone 805 302-3651
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2025
Certificate Expiration Date 7/14/2027
Facility Type Other - BEHAVIORAL HEALTH REHAB
Lab Director NEDA JAVAHERIAN

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