05D1089830 CLIA NUMBER - GREENFIELDS IV ICF-DDN

Laboratory Demographics

CLIA Code: 05D1089830
Facility Name: GREENFIELDS IV ICF-DDN
Facility Address: 101 HAWKESBURY WAY
VALLEJO, CA
ZIP 94591
Facility Phone: 707 552-1756
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: GURPREET S. DHUGGA
NPI Number: 1174713226
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D1089830
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	GREENFIELDS IV ICF-DDN
Street	101 HAWKESBURY WAY
City	VALLEJO
State	CA
ZIP	94591
Phone	707 552-1756
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/26/2024
Certificate Expiration Date	9/25/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	GURPREET S. DHUGGA

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