05D2276364 CLIA NUMBER - PROSPERO WELLNESS CENTER

Laboratory Demographics

CLIA Number: 05D2276364

Facility Name: PROSPERO WELLNESS CENTER

Facility Address:
79448 CALLE PROSPERO
LA QUINTA, CA
ZIP 92253
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Facility Phone Number: 818 441-2177

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1487398921

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	05D2276364
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PROSPERO WELLNESS CENTER
Street	79448 CALLE PROSPERO
City	LA QUINTA
State	CA
ZIP	92253
Phone	818 441-2177
CertificateType	4
CertificateEffectiveDate	2/7/2023
CertificateExpirationDate	2/6/2025
FacilityType	Waiver

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