05D2308638 CLIA NUMBER - MIRACLE REHAB INC.

Laboratory Demographics

  • CLIA Code: 05D2308638
  • Facility Name: MIRACLE REHAB INC.
  • Facility Address: 1527 N VALLEY ST
    BURBANK, CA
    ZIP 91505
  • Facility Phone: 818 588-3783
  • Facility Type: Other - AOD DETOX/REHAB RESIDENTI
  • Facility Type: Waiver
  • Lab Director: LITOS MALLARE
  • NPI Number: 1831978881
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2308638
LAB Type Other - AOD DETOX/REHAB RESIDENTI
Facility Name MIRACLE REHAB INC.
Street 1527 N VALLEY ST
City BURBANK
State CA
ZIP 91505
Phone 818 588-3783
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Other - AOD DETOX/REHAB RESIDENTI
Lab Director LITOS MALLARE

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