05D2194386 CLIA NUMBER - RESURGENCE CALIFORNIA - MADISON

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Laboratory Demographics

CLIA Number: 05D2194386

Facility Name: RESURGENCE CALIFORNIA - MADISON

Facility Address:
3072
COSTA MESA, CA
ZIP 92626
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Facility Phone Number: 949 973-2630

Facility Type: Other - MENTAL HEALTH TREATMENT

Certificate Type: Waiver

NPI Number: 1851871438

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	05D2194386
LAB Type	Other - MENTAL HEALTH TREATMENT
Facility Name	RESURGENCE CALIFORNIA - MADISON
Street	3072
City	COSTA MESA
State	CA
ZIP	92626
Phone	949 973-2630
CertificateType	4
CertificateEffectiveDate	9/30/2022
CertificateExpirationDate	9/29/2024
FacilityType	Waiver

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