05D0885390 CLIA NUMBER - CENTRAL CITY COMMUNITY HEALTH CENTER INC

Laboratory Demographics

CLIA Number: 05D0885390

Facility Name: CENTRAL CITY COMMUNITY HEALTH CENTER INC

Facility Address:
81709 DR CARREON BLVD, STE E-2
INDIO, CA
ZIP 92201
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Facility Phone Number: 760 342-3336

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1508254814

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0885390
LAB Type	Federally Qualified Health Center
Facility Name	CENTRAL CITY COMMUNITY HEALTH CENTER INC
Street	81709 DR CARREON BLVD, STE E-2
City	INDIO
State	CA
ZIP	92201
Phone	760 342-3336
CertificateType	4
CertificateEffectiveDate	4/20/2024
CertificateExpirationDate	4/19/2026
FacilityType	Waiver

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