CLIA lab
CLIA 05D2182549: Providence Lake Forest
Lake Forest, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2182549 belongs to Providence Lake Forest in Lake Forest, CA.
Certificate of Waiver, effective April 22, 2026, expires April 21, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- April 22, 2026
- Certificate expiration
- April 21, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 22, 2020
- Facility type
- Physician office
- Ownership (control type)
- Religious affiliation
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D2182549
- Lab name
- Providence Lake Forest
- Address
- 22621 Lake Forest Drive Suite D1, Lake Forest, CA 92630
- Phone
- (949) 242-6902
- Fax
- (949) 372-3544
Annual test volume the lab reported
- Waived tests
- 200
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Lake Forest, CA
- A Better Life Recovery, LLCCertificate of Waiver, Other05D2136189
- A Better Life Recovery, LLCCertificate of Waiver, Other05D2275646
- A Better Life Recovery, LLCCertificate of Waiver, Other05D2285278
- Adel A Boutros, MDCertificate of Waiver, Physician office05D0897771
- Alcon LaboratoriesCertificate of Waiver, Other05D2279166
- Coastline EndocrinologyCertificate of Waiver, Physician office05D2338903
- Concentra Lake ForestCertificate of Waiver, Physician office05D0958933
- Foothill Gateway Surgery Center LLCCertificate of Waiver, Ambulatory surgery center05D1024936
- Foothill Surgical InstituteCertificate of Waiver, Ambulatory surgery center05D1030512
- Freedom Village Health Care CenterCertificate of Waiver, Skilled nursing or nursing facility05D0880891
Related
Questions
What is the CLIA number for Providence Lake Forest in Lake Forest?
05D2182549, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Lake Forest hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2182549 expire?
The CMS file lists April 21, 2028 as the certificate expiration date; the certificate took effect April 22, 2026.