05D2233457 CLIA NUMBER - SOCAL EMPOWERED LLC

Laboratory Demographics

  • CLIA Code: 05D2233457
  • Facility Name: SOCAL EMPOWERED LLC
  • Facility Address: 22602 COSTA BELLA DR
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 949 701-3551
  • Facility Type: Other - SOCIAL REHABILITATION FAC
  • Facility Type: Waiver
  • Lab Director: SANJAI THANKACHEN
  • NPI Number: 1841859402
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2233457
LAB Type Other - SOCIAL REHABILITATION FAC
Facility Name SOCAL EMPOWERED LLC
Street 22602 COSTA BELLA DR
City LAKE FOREST
State CA
ZIP 92630
Phone 949 701-3551
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Other - SOCIAL REHABILITATION FAC
Lab Director SANJAI THANKACHEN

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This page was last updated on: 9/29/2025