05D2269413 CLIA NUMBER - SOCAL EMPOWERED LLC

Laboratory Demographics

CLIA Code: 05D2269413
Facility Name: SOCAL EMPOWERED LLC
Facility Address: 23671 BRASILIA
MISSION VIEJO, CA
ZIP 92691
Facility Phone: 949 701-3551
Facility Type: Other - SOCIAL REHABILITATION FAC
Facility Type: Waiver
Lab Director: SANJAI J. THANKACHEN
NPI Number: 1851052062
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2269413
LAB Type	Other - SOCIAL REHABILITATION FAC
Facility Name	SOCAL EMPOWERED LLC
Street	23671 BRASILIA
City	MISSION VIEJO
State	CA
ZIP	92691
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	9/26/2024
Certificate Expiration Date	9/25/2026
Facility Type	Other - SOCIAL REHABILITATION FAC
Lab Director	SANJAI J. THANKACHEN

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