05D2174998 CLIA NUMBER - MARINA HARBOR DETOX

Laboratory Demographics

  • CLIA Code: 05D2174998
  • Facility Name: MARINA HARBOR DETOX
  • Facility Address: 289 MARINA BOULEVARD
    SAN FRANCISCO, CA
    ZIP 94123
  • Facility Phone: 415 868-3858
  • Facility Type: Other - RESIDENTIAL DRUG
  • Facility Type: Waiver
  • Lab Director: WILLIAM W. NELSON
  • NPI Number: 1720624497
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2174998
LAB Type Other - RESIDENTIAL DRUG
Facility Name MARINA HARBOR DETOX
Street 289 MARINA BOULEVARD
City SAN FRANCISCO
State CA
ZIP 94123
Phone 415 868-3858
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Other - RESIDENTIAL DRUG
Lab Director WILLIAM W. NELSON

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