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05D2075445 CLIA NUMBER - PROHEALTH HOME CARE INC

Laboratory Demographics

CLIA Number: 05D2075445

Facility Name: PROHEALTH HOME CARE INC

Facility Address:
3255 W MARCH LN STE 105A &105B
STOCKTON, CA
ZIP 95219
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Facility Phone Number: 877 300-6130

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1952855447

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 05D2075445
LAB Type Home Health Agency
Facility Name PROHEALTH HOME CARE INC
Street 3255 W MARCH LN STE 105A &105B
City STOCKTON
State CA
ZIP 95219
Phone 877 300-6130
CertificateType 4
CertificateEffectiveDate 5/18/2023
CertificateExpirationDate 5/17/2025
FacilityType Waiver

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