05D1050969 CLIA NUMBER - WELLBOUND OF SANTA ROSA LLC

Laboratory Demographics

CLIA Number: 05D1050969

Facility Name: WELLBOUND OF SANTA ROSA LLC

Facility Address:
2301 CIRCADIAN WAY SUITE B
SANTA ROSA, CA
ZIP 95407
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Facility Phone Number: 707 541-3410

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1326093626

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1050969
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WELLBOUND OF SANTA ROSA LLC
Street	2301 CIRCADIAN WAY SUITE B
City	SANTA ROSA
State	CA
ZIP	95407
Phone	707 541-3410
CertificateType	4
CertificateEffectiveDate	2/16/2024
CertificateExpirationDate	2/15/2026
FacilityType	Waiver

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