05D2169172 CLIA NUMBER - THE MEADOWGLADE

Laboratory Demographics

  • CLIA Code: 05D2169172
  • Facility Name: THE MEADOWGLADE
  • Facility Address: 301 SCIENCE DRIVE # 210
    MOORPARK, CA
    ZIP 93021
  • Facility Phone: 805 530-5301
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: YOUNG JI J. KIM
  • NPI Number: 1548823032
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2169172
LAB Type Comp. Outpatient Rehab Facility
Facility Name THE MEADOWGLADE
Street 301 SCIENCE DRIVE # 210
City MOORPARK
State CA
ZIP 93021
Phone 805 530-5301
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2023
Certificate Expiration Date 7/15/2025
Facility Type Comp. Outpatient Rehab Facility
Lab Director YOUNG JI J. KIM

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This page was last updated on: 6/4/2025