05D2194689 CLIA NUMBER - AMS PRO GROUP LLC WISH RECOVERY

Laboratory Demographics

  • CLIA Code: 05D2194689
  • Facility Name: AMS PRO GROUP LLC WISH RECOVERY
  • Facility Address: 9460 WISH AVENUE
    NORTHRIDGE, CA
    ZIP 91325
  • Facility Phone: 747 222-8808
  • Facility Type: Other - DETOX FACILITY
  • Facility Type: Waiver
  • Lab Director: WILLIAM D. STANLEY
  • NPI Number: 1104455120
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2194689
LAB Type Other - DETOX FACILITY
Facility Name AMS PRO GROUP LLC WISH RECOVERY
Street 9460 WISH AVENUE
City NORTHRIDGE
State CA
ZIP 91325
Phone 747 222-8808
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Other - DETOX FACILITY
Lab Director WILLIAM D. STANLEY

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This page was last updated on: 3/20/2025