05D2177332 CLIA NUMBER - RESURGENCE CALIFORNIA, LLC RESURGENCE CALIFORNIA - AIRWAY

Laboratory Demographics

CLIA Number: 05D2177332

Facility Name: RESURGENCE CALIFORNIA, LLC RESURGENCE CALIFORNIA - AIRWAY

Facility Address:
3151 AIRWAY AVENUE SUITE K-203
COSTA MESA, CA
ZIP 92626
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Facility Phone Number: 888 700-5053

Facility Type: Other - SUBSTANCE ABUSE TREAT

Certificate Type: Waiver

NPI Number: 1861972325

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	05D2177332
LAB Type	Other - SUBSTANCE ABUSE TREAT
Facility Name	RESURGENCE CALIFORNIA, LLC RESURGENCE CALIFORNIA - AIRWAY
Street	3151 AIRWAY AVENUE SUITE K-203
City	COSTA MESA
State	CA
ZIP	92626
Phone	888 700-5053
CertificateType	4
CertificateEffectiveDate	1/8/2024
CertificateExpirationDate	1/7/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024