05D0998299 CLIA NUMBER - BENNETT VALLEY ICF DD H INC

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Field Name	Field Value
CLIA Number	05D0998299
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BENNETT VALLEY ICF DD H INC
Street	2416 CACTUS AVENUE
City	SANTA ROSA
State	CA
ZIP	95405
Phone	707 544-6465
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/11/2024
Certificate Expiration Date	4/10/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	RONALD BYLEDBAL

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