05D2201023 CLIA NUMBER - INLAND EMPIRE WOMAN'S CENTER MEDICAL ASSOCIATES

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Laboratory Demographics

CLIA Number: 05D2201023

Facility Name: INLAND EMPIRE WOMAN'S CENTER MEDICAL ASSOCIATES

Facility Address:
10459 MOUNTIAN VIEW AVENUE SUITE B
REDLANDS, CA
ZIP 92374
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Facility Phone Number: 909 801-7077

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346691235

Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	05D2201023
LAB Type	Physician Office
Facility Name	INLAND EMPIRE WOMAN'S CENTER MEDICAL ASSOCIATES
Street	10459 MOUNTIAN VIEW AVENUE SUITE B
City	REDLANDS
State	CA
ZIP	92374
Phone	909 801-7077
CertificateType	4
CertificateEffectiveDate	11/18/2022
CertificateExpirationDate	11/17/2024
FacilityType	Waiver

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