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05D2099514 CLIA NUMBER - DEPORRES HOME HEALTHCARE SERVICES

Laboratory Demographics

CLIA Number: 05D2099514

Facility Name: DEPORRES HOME HEALTHCARE SERVICES

Facility Address:
1130 N EL DORADO ST
STOCKTON, CA
ZIP 95202
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Facility Phone Number: 209 938-0121

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1376977462

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 05D2099514
LAB Type Home Health Agency
Facility Name DEPORRES HOME HEALTHCARE SERVICES
Street 1130 N EL DORADO ST
City STOCKTON
State CA
ZIP 95202
Phone 209 938-0121
CertificateType 4
CertificateEffectiveDate 7/28/2023
CertificateExpirationDate 7/27/2025
FacilityType Waiver

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