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05D2085237 CLIA NUMBER - ST. MARY'S HOME HEALTH SERVICES LLC

Laboratory Demographics

CLIA Number: 05D2085237

Facility Name: ST. MARY'S HOME HEALTH SERVICES LLC

Facility Address:
50 SAND CREEK BLVD STE 336
BRENTWOOD, CA
ZIP 94513
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Facility Phone Number: 510 573-5523

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1972942043

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 05D2085237
LAB Type Home Health Agency
Facility Name ST. MARY'S HOME HEALTH SERVICES LLC
Street 50 SAND CREEK BLVD STE 336
City BRENTWOOD
State CA
ZIP 94513
Phone 510 573-5523
CertificateType 4
CertificateEffectiveDate 10/9/2022
CertificateExpirationDate 10/8/2024
FacilityType Waiver

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