05D0888208 CLIA NUMBER - VILLA FAIRMONT MENTAL HEALTH CENTER

Laboratory Demographics

CLIA Code: 05D0888208
Facility Name: VILLA FAIRMONT MENTAL HEALTH CENTER
Facility Address: 15200 FOOTHILL BLVD
SAN LEANDRO, CA
ZIP 94578
Facility Phone: 510 352-9690
Facility Type: Skilled Nursing Facility/Nursing Facility
Facility Type: Waiver
Lab Director: HARVEY SEGALOVE MD
NPI Number: 1073695011
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D0888208
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	VILLA FAIRMONT MENTAL HEALTH CENTER
Street	15200 FOOTHILL BLVD
City	SAN LEANDRO
State	CA
ZIP	94578
Phone	510 352-9690
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/27/2024
Certificate Expiration Date	6/26/2026
Facility Type	Skilled Nursing Facility/Nursing Facility
Lab Director	HARVEY SEGALOVE MD

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