05D2286432 CLIA NUMBER - PH WELLNESS

Laboratory Demographics

CLIA Number: 05D2286432

Facility Name: PH WELLNESS

Facility Address:
7635 DUFFERIN AVENUE
RIVERSIDE, CA
ZIP 92504
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Facility Phone Number: 951 335-5576

Facility Type: Other - SUBSTANCE TREATMENT FACIL

Certificate Type: Waiver

NPI Number: 1841957057

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	05D2286432
LAB Type	Other - SUBSTANCE TREATMENT FACIL
Facility Name	PH WELLNESS
Street	7635 DUFFERIN AVENUE
City	RIVERSIDE
State	CA
ZIP	92504
Phone	951 335-5576
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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