05D0988563 CLIA NUMBER - JAN & GAILS CARE HOME #4

Laboratory Demographics

CLIA Number: 05D0988563

Facility Name: JAN & GAILS CARE HOME #4

Facility Address:
605 ARONIAN ST
TULARE, CA
ZIP 93274
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Facility Phone Number: 559 685-1988

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1144340746

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	05D0988563
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	JAN & GAILS CARE HOME #4
Street	605 ARONIAN ST
City	TULARE
State	CA
ZIP	93274
Phone	559 685-1988
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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