05D2324676 CLIA NUMBER - CRYSTAL COVE RECOVERY, LLC

Laboratory Demographics

  • CLIA Code: 05D2324676
  • Facility Name: CRYSTAL COVE RECOVERY, LLC
  • Facility Address: 540 PARK AVE, UNIT A
    LAGUNA BEACH, CA
    ZIP 92651
  • Facility Phone: 949 353-7162
  • Facility Type: Other - DRUG & ALCOHOL TREATMENT
  • Facility Type: Waiver
  • Lab Director: SANJAI THANKACHEN
  • NPI Number: 1891597175
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2324676
LAB Type Other - DRUG & ALCOHOL TREATMENT
Facility Name CRYSTAL COVE RECOVERY, LLC
Street 540 PARK AVE, UNIT A
City LAGUNA BEACH
State CA
ZIP 92651
Phone 949 353-7162
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Other - DRUG & ALCOHOL TREATMENT
Lab Director SANJAI THANKACHEN

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