05D0722889 CLIA NUMBER - LAKE COUNTY TRIBAL HEALTH

Laboratory Demographics

CLIA Number: 05D0722889

Facility Name: LAKE COUNTY TRIBAL HEALTH

Facility Address:
925 BEVINS COURT
LAKEPORT, CA
ZIP 95453
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Facility Phone Number: 707 263-8382

Facility Type: Other - TRIBAL/IHS JOINT VENTURE

Certificate Type: Microscopy

NPI Number: 1285000810

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0722889
LAB Type	Other - TRIBAL/IHS JOINT VENTURE
Facility Name	LAKE COUNTY TRIBAL HEALTH
Street	925 BEVINS COURT
City	LAKEPORT
State	CA
ZIP	95453
Phone	707 263-8382
CertificateType	3
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	PPMP

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