05D2319296 CLIA NUMBER - BH-VC OPCO SP, LLC DBA JACKSON HOUSE SANTA PAULA

Laboratory Demographics

CLIA Code: 05D2319296
Facility Name: BH-VC OPCO SP, LLC DBA JACKSON HOUSE SANTA PAULA
Facility Address: 811 TELEGRAGH ROAD
SANTA PAULA, CA
ZIP 93060
Facility Phone: 805 265-4232
Facility Type: Other - COMP. RESIDENTIAL REHAB F
Facility Type: Waiver
Lab Director: IRINEL R. CHIRIAC
NPI Number: 1538761010
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2319296
LAB Type	Other - COMP. RESIDENTIAL REHAB F
Facility Name	BH-VC OPCO SP, LLC DBA JACKSON HOUSE SANTA PAULA
Street	811 TELEGRAGH ROAD
City	SANTA PAULA
State	CA
ZIP	93060
Phone	805 265-4232
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/26/2025
Certificate Expiration Date	2/25/2027
Facility Type	Other - COMP. RESIDENTIAL REHAB F
Lab Director	IRINEL R. CHIRIAC

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