05D0887760 CLIA NUMBER - SUNDANCE CREEK POST ACUTE

Laboratory Demographics

  • CLIA Code: 05D0887760
  • Facility Name: SUNDANCE CREEK POST ACUTE
  • Facility Address: 5800 W WILSON ST
    BANNING, CA
    ZIP 92220
  • Facility Phone: 951 845-1606
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PAI SHANTHARAM
  • NPI Number: 1255312831
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0887760
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SUNDANCE CREEK POST ACUTE
Street 5800 W WILSON ST
City BANNING
State CA
ZIP 92220
Phone 951 845-1606
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director PAI SHANTHARAM

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