05D2174998 CLIA NUMBER - MARINA HARBOR DETOX

Laboratory Demographics

CLIA Number: 05D2174998

Facility Name: MARINA HARBOR DETOX

Facility Address:
289 MARINA BOULEVARD
SAN FRANCISCO, CA
ZIP 94123
Get Directions

Facility Phone Number: 415 868-3858

Facility Type: Other - RESIDENTIAL DRUG

Certificate Type: Waiver

NPI Number: 1720624497

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	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
CertificateType	4
CertificateEffectiveDate	11/13/2023
CertificateExpirationDate	11/12/2025
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