05D1003572 CLIA NUMBER - HAZEL HAWKINS CONVALESCENT HOSPITAL NORTHSIDE

Laboratory Demographics

CLIA Number: 05D1003572

Facility Name: HAZEL HAWKINS CONVALESCENT HOSPITAL NORTHSIDE

Facility Address:
900 SUNSET DRIVE
HOLLISTER, CA
ZIP 95023
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Facility Phone Number: 831 635-1106

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1891446761

Taxonomy: 275N00000X - Medicare Defined Swing Bed Unit
A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.

CLIA Record

Field Name	Field Value
CLIA Number	05D1003572
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	HAZEL HAWKINS CONVALESCENT HOSPITAL NORTHSIDE
Street	900 SUNSET DRIVE
City	HOLLISTER
State	CA
ZIP	95023
Phone	831 635-1106
CertificateType	4
CertificateEffectiveDate	9/4/2022
CertificateExpirationDate	9/3/2024
FacilityType	Waiver

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