05D2285479 CLIA NUMBER - 4 SEASONS DETOX AND RECOVERY HOUSE

Laboratory Demographics

CLIA Number: 05D2285479

Facility Name: 4 SEASONS DETOX AND RECOVERY HOUSE

Facility Address:
3174 EVELYN AVE
SIMI VALLEY, CA
ZIP 93063
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Facility Phone Number: 424 225-2288

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1508534934

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	05D2285479
LAB Type	Independent
Facility Name	4 SEASONS DETOX AND RECOVERY HOUSE
Street	3174 EVELYN AVE
City	SIMI VALLEY
State	CA
ZIP	93063
Phone	424 225-2288
CertificateType	4
CertificateEffectiveDate	7/12/2023
CertificateExpirationDate	7/11/2025
FacilityType	Waiver

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