05D2155354 CLIA NUMBER - WELLSPACE HEALTH ALTERNATIVE HOUSE

Laboratory Demographics

CLIA Number: 05D2155354

Facility Name: WELLSPACE HEALTH ALTERNATIVE HOUSE

Facility Address:
1550 JULIESSE AVENUE
SACRAMENTO, CA
ZIP 95815
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Facility Phone Number: 916 313-8434

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1114791332

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2155354
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	WELLSPACE HEALTH ALTERNATIVE HOUSE
Street	1550 JULIESSE AVENUE
City	SACRAMENTO
State	CA
ZIP	95815
Phone	916 313-8434
CertificateType	4
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Waiver

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