05D2085173 CLIA NUMBER - COBBLESTONE HOUSE

Laboratory Demographics

CLIA Code: 05D2085173
Facility Name: COBBLESTONE HOUSE
Facility Address: 13881 COBBLESTONE CT
FONTANA, CA
ZIP 92335
Facility Phone: 909 919-3497
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: MALLU C. REDDY
NPI Number: 1295151710
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2085173
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	COBBLESTONE HOUSE
Street	13881 COBBLESTONE CT
City	FONTANA
State	CA
ZIP	92335
Phone	909 919-3497
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/8/2024
Certificate Expiration Date	10/7/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	MALLU C. REDDY

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