05D0726487 CLIA NUMBER - CREEKSIDE CONVALESCENT HOSPITAL

Laboratory Demographics

  • CLIA Code: 05D0726487
  • Facility Name: CREEKSIDE CONVALESCENT HOSPITAL
  • Facility Address: 850 SONOMA AVENUE
    SANTA ROSA, CA
    ZIP 95404
  • Facility Phone: 707 544-7750
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JAMES C. DEVORE MD
  • NPI Number: 1326734625
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0726487
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CREEKSIDE CONVALESCENT HOSPITAL
Street 850 SONOMA AVENUE
City SANTA ROSA
State CA
ZIP 95404
Phone 707 544-7750
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 JAMES C. DEVORE MD

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