05D2172916 CLIA NUMBER - PRIME ONE CARE ADHC

Laboratory Demographics

  • CLIA Code: 05D2172916
  • Facility Name: PRIME ONE CARE ADHC
  • Facility Address: 3240 N GAREY AVE
    POMONA, CA
    ZIP 91767
  • Facility Phone: 877 201-7377
  • Facility Type: Other - ADULT DAY HEALTH
  • Facility Type: Waiver
  • Lab Director: DALE BRENT
  • NPI Number: 1558902767
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2172916
LAB Type Other - ADULT DAY HEALTH
Facility Name PRIME ONE CARE ADHC
Street 3240 N GAREY AVE
City POMONA
State CA
ZIP 91767
Phone 877 201-7377
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2023
Certificate Expiration Date 9/30/2025
Facility Type Other - ADULT DAY HEALTH
Lab Director DALE BRENT

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This page was last updated on: 3/20/2025