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IRIS HEALING RETREAT LLC
NPI 1861945560
Substance Abuse Rehabilitation Facility in Woodland Hills, CA

Active since July 28, 2016CLIA 05D2136318 · Waiver
5663 JUMILLA AVE, WOODLAND HILLS, CA 91367(323) 449-0016(818) 301-1940 Get Directions Write a Review

NPPES record last updated: October 28, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Iris Healing Retreat Llc NPPES

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

IRIS HEALING RETREAT LLC (NPI 1861945560) is a healthcare organization registered as a substance abuse rehabilitation facility in Woodland Hills, California and active in the NPI registry since July 2016. The organization holds a CLIA Waiver certificate valid through September 6, 2027, maintains a secondary practice location in Woodland Hills, and lists Elena Kapustina, Ceo, as its authorized official.

NPPES Registry Identity

NPI1861945560
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameIRIS HEALING RETREAT LLC
Location Address5663 JUMILLA AVEWoodland Hills, CA 91367-6910
Mailing Address23033 Ostronic DrWoodland Hills, CA 91367-6143 · (818) 436-2646 · Fax (818) 301-1940
Phone(323) 449-0016
Fax(818) 301-1940
Organization SubpartNo
Authorized OfficialElena KapustinaCeo · (323) 449-0016
Enumeration DateJuly 28, 2016
Last NPPES UpdateOctober 28, 2024
NPPES CertifiedOctober 28, 2024
✔ NPI 1861945560 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.
5663 JUMILLA AVE, Woodland Hills, CA 91367
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Secondary Practice Location 1

Location 123033 Ostronic DrWoodland Hills, CA 91367-6143 · Phone (818) 436-2646 · Fax (818) 301-1940

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 05D2136318

Iris Healing Retreat · Woodland Hills, CA
Active · expires Sep 6, 2027
CLIA Number05D2136318
Laboratory TypeAddiction Treatment Ctr
Certificate Effective DateSeptember 7, 2025
Certificate Expiration DateSeptember 6, 2027
Laboratory DirectorLisa M. Benya, Do
Laboratory Phone(844) 663-4747
Laboratory LocationIris Healing Retreat23033 Ostronic Dr, Woodland Hills, CA 91367
CLIA data matches this NPI record on: Address 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 Iris Healing Retreat LLC's NPI number?

The NPI number for Iris Healing Retreat LLC is 1861945560. It was assigned to this organization in the NPPES registry on July 28, 2016.

Where is Iris Healing Retreat LLC located?

Iris Healing Retreat LLC is located at 5663 Jumilla Ave, Woodland Hills, CA 91367. The listed phone number is (323) 449-0016.

What is Iris Healing Retreat LLC's specialty?

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

Does Iris Healing Retreat LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2136318) is associated with this NPI, valid through September 6, 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 Iris Healing Retreat LLC was last updated on October 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.