05D2063284 CLIA NUMBER - WELLSPACE HEALTH BOULEVARD COURT

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Laboratory Demographics

CLIA Number: 05D2063284

Facility Name: WELLSPACE HEALTH BOULEVARD COURT

Facility Address:
5321 STOCKTON BLVD
SACRAMENTO, CA
ZIP 95820
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Facility Phone Number: 916 704-3573

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1104210608

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2063284
LAB Type	Federally Qualified Health Center
Facility Name	WELLSPACE HEALTH BOULEVARD COURT
Street	5321 STOCKTON BLVD
City	SACRAMENTO
State	CA
ZIP	95820
Phone	916 704-3573
CertificateType	4
CertificateEffectiveDate	7/31/2023
CertificateExpirationDate	7/30/2025
FacilityType	Waiver

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