05D2290228 CLIA NUMBER - NEWPORT ACADEMY - APPLEWOOD

Laboratory Demographics

  • CLIA Code: 05D2290228
  • Facility Name: NEWPORT ACADEMY - APPLEWOOD
  • Facility Address: 2269 APPLEWOOD LANE
    SANTA ROSA VALLEY, CA
    ZIP 93012
  • Facility Phone: 714 393-3523
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TARIK HADZIC
  • NPI Number: 1578280517
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2290228
LAB Type Practitioner Other
Facility Name NEWPORT ACADEMY - APPLEWOOD
Street 2269 APPLEWOOD LANE
City SANTA ROSA VALLEY
State CA
ZIP 93012
Phone 714 393-3523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2025
Certificate Expiration Date 9/20/2027
Facility Type Practitioner Other
Lab Director TARIK HADZIC

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