05D0643096 CLIA NUMBER - JACOB HEALTH CARE CENTER LLC

Laboratory Demographics

CLIA Number: 05D0643096

Facility Name: JACOB HEALTH CARE CENTER LLC

Facility Address:
4075 54TH STREET
SAN DIEGO, CA
ZIP 92105
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Facility Phone Number: 619 582-5168

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1851709893

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	05D0643096
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	JACOB HEALTH CARE CENTER LLC
Street	4075 54TH STREET
City	SAN DIEGO
State	CA
ZIP	92105
Phone	619 582-5168
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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