05D0987250 CLIA NUMBER - GREENFIELDS III ICF DDN

Laboratory Demographics

CLIA Code: 05D0987250
Facility Name: GREENFIELDS III ICF DDN
Facility Address: 100MORGAN STREET
VALLEJO, CA
ZIP 94591
Facility Phone: 707 643-3948
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: RODOLFO A. DAQUIOAG MD
NPI Number: 1992915953
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D0987250
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	GREENFIELDS III ICF DDN
Street	100MORGAN STREET
City	VALLEJO
State	CA
ZIP	94591
Phone	707 643-3948
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	5/31/2025
Certificate Expiration Date	5/30/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	RODOLFO A. DAQUIOAG MD

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