05D2237149 CLIA NUMBER - LEAD RECOVERY TRANSITIONAL LIVING CENTER, LLC

Laboratory Demographics

CLIA Number: 05D2237149

Facility Name: LEAD RECOVERY TRANSITIONAL LIVING CENTER, LLC

Facility Address:
192 SOUTH CRAIG DRIVE
ORANGE, CA
ZIP 92869
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Facility Phone Number: 800 380-0012

Facility Type: Other - INPATIENT DUAL DIAGNOSIS

Certificate Type: Waiver

NPI Number: 1306472832

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	05D2237149
LAB Type	Other - INPATIENT DUAL DIAGNOSIS
Facility Name	LEAD RECOVERY TRANSITIONAL LIVING CENTER, LLC
Street	192 SOUTH CRAIG DRIVE
City	ORANGE
State	CA
ZIP	92869
Phone	800 380-0012
CertificateType	4
CertificateEffectiveDate	9/22/2023
CertificateExpirationDate	9/21/2025
FacilityType	Waiver

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