05D2248079 CLIA NUMBER - MAPLE MOON LLC

Laboratory Demographics

  • CLIA Code: 05D2248079
  • Facility Name: MAPLE MOON LLC
  • Facility Address: 20400 HEMMINGWAY ST
    WINNETKA, CA
    ZIP 91306
  • Facility Phone: 818 626-9790
  • Facility Type: Other - RESIDENTIAL DRUG TREATMEN
  • Facility Type: Waiver
  • Lab Director: COURTNEY S. SCOTT
  • NPI Number: 1184384786
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2248079
LAB Type Other - RESIDENTIAL DRUG TREATMEN
Facility Name MAPLE MOON LLC
Street 20400 HEMMINGWAY ST
City WINNETKA
State CA
ZIP 91306
Phone 818 626-9790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Other - RESIDENTIAL DRUG TREATMEN
Lab Director COURTNEY S. SCOTT

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