05D2190011 CLIA NUMBER - WEST VALLEY DETENTION CENTER

Home > CLIA Lookup > 05D2190011

Laboratory Demographics

CLIA Number: 05D2190011

Facility Name: WEST VALLEY DETENTION CENTER

Facility Address:
9500 ETIWANDA AVE
RANCHO CUCAMONGA, CA
ZIP 91739
Get Directions

Facility Phone Number: 909 463-5001

Facility Type: Other - COUNTY JAIL

Certificate Type: Waiver

NPI Number: 1669681961

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	05D2190011
LAB Type	Other - COUNTY JAIL
Facility Name	WEST VALLEY DETENTION CENTER
Street	9500 ETIWANDA AVE
City	RANCHO CUCAMONGA
State	CA
ZIP	91739
Phone	909 463-5001
CertificateType	4
CertificateEffectiveDate	8/7/2022
CertificateExpirationDate	8/6/2024
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