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05D2030875 CLIA NUMBER - ST JUDE HOME HEALTH AGENCY

Laboratory Demographics

CLIA Number: 05D2030875

Facility Name: ST JUDE HOME HEALTH AGENCY

Facility Address:
4725 FIRST ST, STE 274
PLEASANTON, CA
ZIP 94566
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Facility Phone Number: 925 474-3439

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1598067415

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 05D2030875
LAB Type Home Health Agency
Facility Name ST JUDE HOME HEALTH AGENCY
Street 4725 FIRST ST, STE 274
City PLEASANTON
State CA
ZIP 94566
Phone 925 474-3439
CertificateType 4
CertificateEffectiveDate 10/6/2023
CertificateExpirationDate 10/5/2025
FacilityType Waiver

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