05D2276395 CLIA NUMBER - VALLEY STAR MLK BHC CRISIS RESIDENTIAL TREATMENT

Laboratory Demographics

  • CLIA Code: 05D2276395
  • Facility Name: VALLEY STAR MLK BHC CRISIS RESIDENTIAL TREATMENT
  • Facility Address: 12021 WILMINGTON AVE.
    LOS ANGELES, CA
    ZIP 90059
  • Facility Phone: 213 222-1681
  • Facility Type: Other - CRISIS RESIDENTIAL TREATM
  • Facility Type: Waiver
  • Lab Director: WEIMING CHU
  • NPI Number: 1912651902
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2276395
LAB Type Other - CRISIS RESIDENTIAL TREATM
Facility Name VALLEY STAR MLK BHC CRISIS RESIDENTIAL TREATMENT
Street 12021 WILMINGTON AVE.
City LOS ANGELES
State CA
ZIP 90059
Phone 213 222-1681
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Other - CRISIS RESIDENTIAL TREATM
Lab Director WEIMING CHU

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This page was last updated on: 6/4/2025