05D2027859 CLIA NUMBER - SUNSHINE INTERMEDIATE CARE FACILITY-DDN

Laboratory Demographics

CLIA Code: 05D2027859
Facility Name: SUNSHINE INTERMEDIATE CARE FACILITY-DDN
Facility Address: 1701 W ELM ST
LODI, CA
ZIP 95242
Facility Phone: 209 365-6878
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: KAMALI AZIZULAH MD
NPI Number: 1437473063
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2027859
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SUNSHINE INTERMEDIATE CARE FACILITY-DDN
Street	1701 W ELM ST
City	LODI
State	CA
ZIP	95242
Phone	209 365-6878
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/3/2025
Certificate Expiration Date	8/2/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	KAMALI AZIZULAH MD

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