05D0855613 CLIA NUMBER - UNICARE COMMUNITY HEALTH CENTER, INC

Laboratory Demographics

CLIA Number: 05D0855613

Facility Name: UNICARE COMMUNITY HEALTH CENTER, INC

Facility Address:
17500 FOOTHILL BLVD, SUITE A-2
FONTANA, CA
ZIP 92335
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Facility Phone Number: 909 428-0170

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1003373812

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0855613
LAB Type	Federally Qualified Health Center
Facility Name	UNICARE COMMUNITY HEALTH CENTER, INC
Street	17500 FOOTHILL BLVD, SUITE A-2
City	FONTANA
State	CA
ZIP	92335
Phone	909 428-0170
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