05D1025305 CLIA NUMBER - STOCKTON HOME TRAINING DIALYSIS

Laboratory Demographics

CLIA Number: 05D1025305

Facility Name: STOCKTON HOME TRAINING DIALYSIS

Facility Address:
5608 N PERSHING AVE
STOCKTON, CA
ZIP 95207
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Facility Phone Number: 209 954-9563

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1437124476

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1025305
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	STOCKTON HOME TRAINING DIALYSIS
Street	5608 N PERSHING AVE
City	STOCKTON
State	CA
ZIP	95207
Phone	209 954-9563
CertificateType	4
CertificateEffectiveDate	2/26/2023
CertificateExpirationDate	2/25/2025
FacilityType	Waiver

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