05D1093423 CLIA NUMBER - ELICA HEALTH CENTERS

Laboratory Demographics

CLIA Number: 05D1093423

Facility Name: ELICA HEALTH CENTERS

Facility Address:
3701 J STREET, STE 201
SACRAMENTO, CA
ZIP 95816
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Facility Phone Number: 916 454-2345

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1093974065

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1093423
LAB Type	Federally Qualified Health Center
Facility Name	ELICA HEALTH CENTERS
Street	3701 J STREET, STE 201
City	SACRAMENTO
State	CA
ZIP	95816
Phone	916 454-2345
CertificateType	4
CertificateEffectiveDate	12/2/2023
CertificateExpirationDate	12/1/2025
FacilityType	Waiver

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