05D2307779 CLIA NUMBER - BH-SD DD OPCO, LLC DBA JACKSON HOUSE RECOVERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2307779
  • Facility Name: BH-SD DD OPCO, LLC DBA JACKSON HOUSE RECOVERY CENTER
  • Facility Address: 2456 E ST
    SAN DIEGO, CA
    ZIP 92102
  • Facility Phone: 619 503-7680
  • Facility Type: Other - COMP RESID REHAB FACILITY
  • Facility Type: Waiver
  • Lab Director: IRINEL R. CHIRIAC
  • NPI Number: 1629627609
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2307779
LAB Type Other - COMP RESID REHAB FACILITY
Facility Name BH-SD DD OPCO, LLC DBA JACKSON HOUSE RECOVERY CENTER
Street 2456 E ST
City SAN DIEGO
State CA
ZIP 92102
Phone 619 503-7680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Other - COMP RESID REHAB FACILITY
Lab Director IRINEL R. CHIRIAC

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