05D0618332 CLIA NUMBER - ADVENTIST HEALTH CLEARLAKE HOSPITAL INC DBA ADVENTIST HEALTH CLEARLAKE (CORNING)

Laboratory Demographics

CLIA Number: 05D0618332

Facility Name: ADVENTIST HEALTH CLEARLAKE HOSPITAL INC DBA ADVENTIST HEALTH CLEARLAKE (CORNING)

Facility Address:
155 SOLANO ST ,
CORNING, CA
ZIP 96021
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Facility Phone Number: 530 824-4669

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1417416124

Taxonomy: 2085B0100X - Radiology
A Radiology doctor of Osteopathy that specializes in Body Imaging.

CLIA Record

Field Name	Field Value
CLIA Number	05D0618332
LAB Type	Rural Health Clinic
Facility Name	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC DBA ADVENTIST HEALTH CLEARLAKE (CORNING)
Street	155 SOLANO ST ,
City	CORNING
State	CA
ZIP	96021
Phone	530 824-4669
CertificateType	4
CertificateEffectiveDate	4/25/2024
CertificateExpirationDate	4/24/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024