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WELLNESS DETOX LA LLC
NPI 1689489023
Substance Abuse Rehabilitation Facility in Pomona, CA

Active since February 12, 2025CLIA 05D2336219 · Waiver
631 E PHILLIPS BLVD, POMONA, CA 91766(909) 589-6783(949) 606-0488 Get Directions Write a Review

NPPES record last updated: February 12, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wellness Detox La Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLNESS DETOX LA LLC (NPI 1689489023) is a healthcare organization registered as a substance abuse rehabilitation facility in Pomona, California and active in the NPI registry since February 2025. The organization holds a CLIA Waiver certificate valid through December 28, 2027 and lists Nicholas Adam Petrillo, Ceo, as its authorized official.

NPPES Registry Identity

NPI1689489023
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameWELLNESS DETOX LA LLC
Location Address631 E PHILLIPS BLVDPomona, CA 91766-4569
Mailing Address621 Nw 53rd St Ste 370Boca Raton, FL 33487-8241 · (978) 440-3200
Phone(909) 589-6783
Fax(949) 606-0488
Organization SubpartNo
Authorized OfficialNicholas Adam PetrilloCeo · (978) 440-3200
Enumeration DateFebruary 12, 2025
NPPES CertifiedFebruary 12, 2025
✔ NPI 1689489023 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
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.
631 E PHILLIPS BLVD, Pomona, CA 91766
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2336219

Wellness Detox La LLC · Pomona, CA
Active · expires Dec 28, 2027
CLIA Number05D2336219
Laboratory TypeDetox/Residential Sud
Certificate Effective DateDecember 29, 2025
Certificate Expiration DateDecember 28, 2027
Laboratory DirectorColleen Weissmann
Laboratory Phone(909) 837-2354
Laboratory LocationWellness Detox La LLC625 E Phillips Blvd, Pomona, CA 91766
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wellness Detox La LLC's NPI number?

The NPI number for Wellness Detox La LLC is 1689489023. It was assigned to this organization in the NPPES registry on February 12, 2025.

Where is Wellness Detox La LLC located?

Wellness Detox La LLC is located at 631 E Phillips Blvd, Pomona, CA 91766. The listed phone number is (909) 589-6783.

What is Wellness Detox La LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Wellness Detox La LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2336219) is associated with this NPI, valid through December 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wellness Detox La LLC was last updated on February 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.