05D2329685 CLIA NUMBER - MDE & KAE HOLDING LLC, DBA PEACEFUL BEGINNING

Laboratory Demographics

  • CLIA Code: 05D2329685
  • Facility Name: MDE & KAE HOLDING LLC, DBA PEACEFUL BEGINNING
  • Facility Address: 9509 JELLICO AVENUE
    NORTHRIDGE, CA
    ZIP 91325
  • Facility Phone: 747 202-0939
  • Facility Type: Other - RESIDENTIAL ALCOHOL/DRUG
  • Facility Type: Waiver
  • Lab Director: JAYSON HYMES
  • NPI Number: 1518841717
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2329685
LAB Type Other - RESIDENTIAL ALCOHOL/DRUG
Facility Name MDE & KAE HOLDING LLC, DBA PEACEFUL BEGINNING
Street 9509 JELLICO AVENUE
City NORTHRIDGE
State CA
ZIP 91325
Phone 747 202-0939
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2025
Certificate Expiration Date 9/3/2027
Facility Type Other - RESIDENTIAL ALCOHOL/DRUG
Lab Director JAYSON HYMES

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