05D1096007 CLIA NUMBER - ENSIGN SONOMA, LLC DBA BROADWAY VILLA POST ACUTE

Laboratory Demographics

  • CLIA Code: 05D1096007
  • Facility Name: ENSIGN SONOMA, LLC DBA BROADWAY VILLA POST ACUTE
  • Facility Address: 1250 BROADWAY
    SONOMA, CA
    ZIP 95476
  • Facility Phone: 707 938-8406
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DAVID G. STREETER
  • NPI Number: 1871594614
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D1096007
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name ENSIGN SONOMA, LLC DBA BROADWAY VILLA POST ACUTE
Street 1250 BROADWAY
City SONOMA
State CA
ZIP 95476
Phone 707 938-8406
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2025
Certificate Expiration Date 2/22/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DAVID G. STREETER

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