05D0684082 CLIA NUMBER - LASSEN INDIAN HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0684082

Facility Name: LASSEN INDIAN HEALTH CENTER

Facility Address:
795 JOAQUIN STREET
SUSANVILLE, CA
ZIP 96130
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Facility Phone Number: 530 257-2542

Facility Type: Other - INDIAN HLTH SRVS RURAL CL

Certificate Type: Waiver

NPI Number: 1275539793

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D0684082
LAB Type	Other - INDIAN HLTH SRVS RURAL CL
Facility Name	LASSEN INDIAN HEALTH CENTER
Street	795 JOAQUIN STREET
City	SUSANVILLE
State	CA
ZIP	96130
Phone	530 257-2542
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