05D2294856 CLIA NUMBER - COACHELLA VALLEY RECOVERY CENTER

Laboratory Demographics

CLIA Number: 05D2294856

Facility Name: COACHELLA VALLEY RECOVERY CENTER

Facility Address:
29660 AVENIDA LA VISTA
CATHEDRAL CITY, CA
ZIP 92234
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Facility Phone Number: 442 888-6482

Facility Type: Other - DRUG ALCOHOL TREATMENT CE

Certificate Type: Waiver

NPI Number: 1417625633

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	05D2294856
LAB Type	Other - DRUG ALCOHOL TREATMENT CE
Facility Name	COACHELLA VALLEY RECOVERY CENTER
Street	29660 AVENIDA LA VISTA
City	CATHEDRAL CITY
State	CA
ZIP	92234
Phone	442 888-6482
CertificateType	4
CertificateEffectiveDate	11/30/2023
CertificateExpirationDate	11/29/2025
FacilityType	Waiver

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