05D0714424 CLIA NUMBER - FAIRMONT REHABILITATION HOSPITAL

Laboratory Demographics

  • CLIA Code: 05D0714424
  • Facility Name: FAIRMONT REHABILITATION HOSPITAL
  • Facility Address: 950 S FAIRMONT AVE
    LODI, CA
    ZIP 95240
  • Facility Phone: 209 368-0693
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHIRAZ BUHARI
  • NPI Number: 1942256391
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0714424
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FAIRMONT REHABILITATION HOSPITAL
Street 950 S FAIRMONT AVE
City LODI
State CA
ZIP 95240
Phone 209 368-0693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHIRAZ BUHARI

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This page was last updated on: 9/29/2025