05D2268361 CLIA NUMBER - LIGHTFULLY BEHAVIORAL HEALTH

Laboratory Demographics

CLIA Code: 05D2268361
Facility Name: LIGHTFULLY BEHAVIORAL HEALTH
Facility Address: 641 ELKINS RD
LOS ANGELES, CA
ZIP 90049
Facility Phone: 424 273-1577
Facility Type: Skilled Nursing Facility/Nursing Facility
Facility Type: Waiver
Lab Director: ERIC M. WEXLER
NPI Number: 1598410524
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2268361
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	LIGHTFULLY BEHAVIORAL HEALTH
Street	641 ELKINS RD
City	LOS ANGELES
State	CA
ZIP	90049
Phone	424 273-1577
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/9/2024
Certificate Expiration Date	9/8/2026
Facility Type	Skilled Nursing Facility/Nursing Facility
Lab Director	ERIC M. WEXLER

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