05D2164740 CLIA NUMBER - PRIMARY CARE AT HOME INC

Laboratory Demographics

CLIA Number: 05D2164740

Facility Name: PRIMARY CARE AT HOME INC

Facility Address:
400 29TH STREET, SUITE 306
OAKLAND, CA
ZIP 94609
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Facility Phone Number: 510 320-2711

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1962852939

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2164740
LAB Type	Community Clinic
Facility Name	PRIMARY CARE AT HOME INC
Street	400 29TH STREET, SUITE 306
City	OAKLAND
State	CA
ZIP	94609
Phone	510 320-2711
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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