05D2312949 CLIA NUMBER - HIDEAWAY RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 05D2312949
  • Facility Name: HIDEAWAY RECOVERY LLC
  • Facility Address: 68910 CONCEPCION RD
    CATHEDRAL CITY, CA
    ZIP 92234
  • Facility Phone: 760 641-0316
  • Facility Type: Other - MEDICAL DETOX FACILITY
  • Facility Type: Waiver
  • Lab Director: SANJAI THANKACHEN
  • NPI Number: 1033813191
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2312949
LAB Type Other - MEDICAL DETOX FACILITY
Facility Name HIDEAWAY RECOVERY LLC
Street 68910 CONCEPCION RD
City CATHEDRAL CITY
State CA
ZIP 92234
Phone 760 641-0316
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2024
Certificate Expiration Date 10/21/2026
Facility Type Other - MEDICAL DETOX FACILITY
Lab Director SANJAI THANKACHEN

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