05D2170545 CLIA NUMBER - FOREVER ACTIVE ADHC

Laboratory Demographics

  • CLIA Code: 05D2170545
  • Facility Name: FOREVER ACTIVE ADHC
  • Facility Address: 1111 WEST GLENOAKS BOULEVARD
    GLENDALE, CA
    ZIP 91202
  • Facility Phone: 818 489-0463
  • Facility Type: Other - ADULT DAY HEALTH
  • Facility Type: Waiver
  • Lab Director: DAVID CHARCHIAN
  • NPI Number: 1528538857
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2170545
LAB Type Other - ADULT DAY HEALTH
Facility Name FOREVER ACTIVE ADHC
Street 1111 WEST GLENOAKS BOULEVARD
City GLENDALE
State CA
ZIP 91202
Phone 818 489-0463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Other - ADULT DAY HEALTH
Lab Director DAVID CHARCHIAN

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