CLIA lab
CLIA 12D1079401: Pearl City Specialized Residential Svcs Program
Pearl City, HI. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 12D1079401 belongs to Pearl City Specialized Residential Svcs Program in Pearl City, HI.
Certificate of Waiver, effective June 17, 2025, expires June 16, 2027.
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
- June 17, 2025
- Certificate expiration
- June 16, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- January 30, 2008
- Facility type
- Other
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 5
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 12D1079401
- Lab name
- Pearl City Specialized Residential Svcs Program
- Address
- 1668 Ho'ohulu St, Pearl City, HI 96782
- Phone
- (808) 533-3936
- Fax
- (808) 650-2958
Annual test volume the lab reported
- Waived tests
- 20
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Pearl City, HI
- Carlos B C Lam MDCertificate of Waiver, Physician office12D0692532
- Castle Physician NetworkCertificate of Waiver, Other12D2253716
- Hawaii State Doh-Hi State Laboratories DivisionCertificate of Compliance, Public health laboratory12D0646259
- Leeward Community College Health CenterCertificate of Waiver, School or student health service12D0970413
- Pacific Endoscopy Center LLCCertificate of Waiver, Ambulatory surgery center12D1073204
- Pearl City Nursing HomeCertificate of Waiver, Skilled nursing or nursing facility12D0914311
- Plaza at Pearl City, LPCertificate of Waiver, Assisted living facility12D2194274
Related
Questions
What is the CLIA number for Pearl City Specialized Residential Svcs Program in Pearl City?
12D1079401, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Pearl City Specialized Residential Svcs Program hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 12D1079401 expire?
The CMS file lists June 16, 2027 as the certificate expiration date; the certificate took effect June 17, 2025.