05D2316801 CLIA NUMBER - BH-IC OPCO, LLC DBA JACKSON HOUSE EL CENTRO

Laboratory Demographics

CLIA Code: 05D2316801
Facility Name: BH-IC OPCO, LLC DBA JACKSON HOUSE EL CENTRO
Facility Address: 2364 S 2ND ST
EL CENTRO, CA
ZIP 92243
Facility Phone: 760 332-1468
Facility Type: Other - COMP RESIDENTIAL REHAB FA
Facility Type: Waiver
Lab Director: IRINEL CHIRIAC
NPI Number: 1104389204
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2316801
LAB Type	Other - COMP RESIDENTIAL REHAB FA
Facility Name	BH-IC OPCO, LLC DBA JACKSON HOUSE EL CENTRO
Street	2364 S 2ND ST
City	EL CENTRO
State	CA
ZIP	92243
Phone	760 332-1468
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/13/2025
Certificate Expiration Date	1/12/2027
Facility Type	Other - COMP RESIDENTIAL REHAB FA
Lab Director	IRINEL CHIRIAC

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