05D2309637 CLIA NUMBER - 417 SOUTH RIVER LLC

Laboratory Demographics

  • CLIA Code: 05D2309637
  • Facility Name: 417 SOUTH RIVER LLC
  • Facility Address: 33050 ANTELOPE RD, STE 201
    MURRIETA, CA
    ZIP 92563
  • Facility Phone: 760 702-5713
  • Facility Type: Other - INTENSIVE OUTPATIENT
  • Facility Type: Waiver
  • Lab Director: ALEJANDRO ALVA
  • NPI Number: 1891571659
  • Taxonomy: 3245S0500X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2309637
LAB Type Other - INTENSIVE OUTPATIENT
Facility Name 417 SOUTH RIVER LLC
Street 33050 ANTELOPE RD, STE 201
City MURRIETA
State CA
ZIP 92563
Phone 760 702-5713
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Other - INTENSIVE OUTPATIENT
Lab Director ALEJANDRO ALVA

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This page was last updated on: 6/4/2025