05D1100522 CLIA NUMBER - SHIRLEY'S ICF/DD-N NO 3

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CLIA Record

Field Name Field Value
CLIA Number 05D1100522
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name SHIRLEY'S ICF/DD-N NO 3
Street 2330 SHROPSHIRE DRIVE
City STOCKTON
State CA
ZIP 95209
Phone 209 476-8703
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director RAGHUNATH K. REDDY, MD

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