05D2316719 CLIA NUMBER - BH-TC OPCO, LLC DBA JACKSON HOUSE TULARE

Laboratory Demographics

CLIA Code: 05D2316719
Facility Name: BH-TC OPCO, LLC DBA JACKSON HOUSE TULARE
Facility Address: 1168 LELAND AVE
TULARE, CA
ZIP 93274
Facility Phone: 559 336-1776
Facility Type: Other - COMP RESIDENTIAL REHAB FA
Facility Type: Waiver
Lab Director: IRINEL CHIRIAC
NPI Number: 1447977582
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2316719
LAB Type	Other - COMP RESIDENTIAL REHAB FA
Facility Name	BH-TC OPCO, LLC DBA JACKSON HOUSE TULARE
Street	1168 LELAND AVE
City	TULARE
State	CA
ZIP	93274
Phone	559 336-1776
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/10/2025
Certificate Expiration Date	1/9/2027
Facility Type	Other - COMP RESIDENTIAL REHAB FA
Lab Director	IRINEL CHIRIAC

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