05D2101819 CLIA NUMBER - ANGEL'S HOME ICF, INC.

Laboratory Demographics

  • CLIA Code: 05D2101819
  • Facility Name: ANGEL'S HOME ICF, INC.
  • Facility Address: 10712 WATERBURY DR
    STOCKTON, CA
    ZIP 95209
  • Facility Phone: 209 851-8842
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: AZIZ KAMALI, MD
  • NPI Number: 1205224334
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2101819
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name ANGEL'S HOME ICF, INC.
Street 10712 WATERBURY DR
City STOCKTON
State CA
ZIP 95209
Phone 209 851-8842
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director AZIZ KAMALI, MD

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