05D2298389 CLIA NUMBER - COASTWISE INTEGRATED RECOVERY INC

Laboratory Demographics

  • CLIA Code: 05D2298389
  • Facility Name: COASTWISE INTEGRATED RECOVERY INC
  • Facility Address: 1366 W 7TH ST
    SAN PEDRO, CA
    ZIP 90732
  • Facility Phone: 310 351-3528
  • Facility Type: Other - SUBSTANCE ABUSE FACILITY
  • Facility Type: Waiver
  • Lab Director: KEVIN SIMONSON
  • NPI Number: 1588386973
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2298389
LAB Type Other - SUBSTANCE ABUSE FACILITY
Facility Name COASTWISE INTEGRATED RECOVERY INC
Street 1366 W 7TH ST
City SAN PEDRO
State CA
ZIP 90732
Phone 310 351-3528
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Other - SUBSTANCE ABUSE FACILITY
Lab Director KEVIN SIMONSON

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