05D2081176 CLIA NUMBER - SAN BERNARDINO HOME TRAINING

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Laboratory Demographics

CLIA Number: 05D2081176

Facility Name: SAN BERNARDINO HOME TRAINING

Facility Address:
966 E HOSPITALITY LN
SAN BERNARDINO, CA
ZIP 92408
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Facility Phone Number: 909 796-8421

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1306267364

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2081176
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SAN BERNARDINO HOME TRAINING
Street	966 E HOSPITALITY LN
City	SAN BERNARDINO
State	CA
ZIP	92408
Phone	909 796-8421
CertificateType	4
CertificateEffectiveDate	7/21/2022
CertificateExpirationDate	7/20/2024
FacilityType	Waiver

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