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05D2104106 CLIA NUMBER - CHENEY HOME ICF-DDN II

Laboratory Demographics

CLIA Number: 05D2104106

Facility Name: CHENEY HOME ICF-DDN II

Facility Address:
2166 BOCA RATON ST
HAYWARD, CA
ZIP 94545
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Facility Phone Number: 510 293-0360

Facility Type: Other - ICF-DD/N

Certificate Type: Waiver
NPI Number: 1316315146

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name Field Value
CLIA Number 05D2104106
LAB Type Other - ICF-DD/N
Facility Name CHENEY HOME ICF-DDN II
Street 2166 BOCA RATON ST
City HAYWARD
State CA
ZIP 94545
Phone 510 293-0360
CertificateType 4
CertificateEffectiveDate 10/27/2023
CertificateExpirationDate 10/26/2025
FacilityType Waiver

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