05D0703816 CLIA NUMBER - MOUNTAINS COMMUNITY HOSPITAL RURAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 05D0703816

Facility Name: MOUNTAINS COMMUNITY HOSPITAL RURAL HEALTH CLINIC

Facility Address:
29099 HOSPITAL ROAD
LAKE ARROWHEAD, CA
ZIP 92352
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Facility Phone Number: 909 436-3033

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1528172541

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0703816
LAB Type	Rural Health Clinic
Facility Name	MOUNTAINS COMMUNITY HOSPITAL RURAL HEALTH CLINIC
Street	29099 HOSPITAL ROAD
City	LAKE ARROWHEAD
State	CA
ZIP	92352
Phone	909 436-3033
CertificateType	4
CertificateEffectiveDate	5/20/2023
CertificateExpirationDate	5/19/2025
FacilityType	Waiver

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