05D1086638 CLIA NUMBER - SHIRLEY'S 1CF DDN #5

Laboratory Demographics

  • CLIA Code: 05D1086638
  • Facility Name: SHIRLEY'S 1CF DDN #5
  • Facility Address: 1182 DUVALL CT
    STOCKTON, CA
    ZIP 95210
  • Facility Phone: 209 475-9829
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: RAGHUNATH REDDY MD
  • NPI Number: 1053563536
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D1086638
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name SHIRLEY'S 1CF DDN #5
Street 1182 DUVALL CT
City STOCKTON
State CA
ZIP 95210
Phone 209 475-9829
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2024
Certificate Expiration Date 7/15/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director RAGHUNATH REDDY MD

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