PETRA WELLNESS, INC
NPI 1508618612
Substance Abuse Rehabilitation Facility in Woodland Hills, CA
- Organization
- Substance Abuse Rehabilitation Facility
- CLIA Number: 05D2342803
- CLIA Cert. Type: Other - MEDICAL DETOX CENTER
- CLIA Exp. Date: 04-26-2028
About PETRA WELLNESS, INC
This page provides the complete NPI Profile along with additional information for Petra Wellness, Inc, a provider established in Woodland Hills, California operating as a Substance Abuse Rehabilitation Facility. The healthcare provider is registered in the NPI registry with number 1508618612 assigned on April 2024. The practitioner's primary taxonomy code is 324500000X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Cody Neeley (Ceo)
- NPI
- 1508618612 Verify this NPI
- Provider Name
- PETRA WELLNESS, INC
- Entity Type
- Organization
- Location Address
- 22839 DOLOROSA ST WOODLAND HILLS, CA 91367
- Location Phone
- (918) 964-3632
- Mailing Address
- 2200 N FLORIDA MANGO RD STE 301 WEST PALM BEACH, FL 33409
- Mailing Phone
- (561) 531-0334
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-02-2024
- Last Update Date
- 10-20-2025
- Code Navigator
Location Map
Secondary Locations
- 22841 1/2 Dolorosa St
Woodland Hills, CA 91367
(918) 964-3632 - 22841 Dolorosa St
Woodland Hills, CA 91367
(918) 964-3632
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Substance Abuse Rehabilitation Facility
- Taxonomy Code
- 324500000X
- Type
- Residential Treatment Facilities
- Taxonomy Description
- A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2342803
- Facility Type
- Other - MEDICAL DETOX CENTER
- Certificate Effective Date
- April 27, 2026
- Certificate Expiration Date
- April 26, 2028
- Laboratory Director
- ERIC CHAGHOURI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Petra Wellness, Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
WOODLAND HILLS, CA 91367
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1508618612, enumerated as an "organization" on April 02, 2024.
The provider is located at 22839 DOLOROSA ST WOODLAND HILLS, CA 91367 and the phone number is (918) 964-3632.
Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.
