05D2173054 CLIA NUMBER - WELLNESS RETREAT RECOVERY CENTER

Laboratory Demographics

CLIA Number: 05D2173054

Facility Name: WELLNESS RETREAT RECOVERY CENTER

Facility Address:
10615 CROTHERS ROAD
SAN JOSE, CA
ZIP 95127
Get Directions

Facility Phone Number: 855 762-3757

Facility Type: Other - INPATIENT SUBSTANCE ABUSE

Certificate Type: Waiver

NPI Number: 1760850945

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	05D2173054
LAB Type	Other - INPATIENT SUBSTANCE ABUSE
Facility Name	WELLNESS RETREAT RECOVERY CENTER
Street	10615 CROTHERS ROAD
City	SAN JOSE
State	CA
ZIP	95127
Phone	855 762-3757
CertificateType	4
CertificateEffectiveDate	10/4/2023
CertificateExpirationDate	10/3/2025
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