05D2188392 CLIA NUMBER - HEALING GROVE HEALTH CENTER INC A SOCIAL PURPOSE CORPORATION

Laboratory Demographics

CLIA Number: 05D2188392

Facility Name: HEALING GROVE HEALTH CENTER INC A SOCIAL PURPOSE CORPORATION

Facility Address:
448 GOODYEAR ST
SAN JOSE, CA
ZIP 95110
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Facility Phone Number: 405 483-6338

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1205465747

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2188392
LAB Type	Physician Office
Facility Name	HEALING GROVE HEALTH CENTER INC A SOCIAL PURPOSE CORPORATION
Street	448 GOODYEAR ST
City	SAN JOSE
State	CA
ZIP	95110
Phone	405 483-6338
CertificateType	3
CertificateEffectiveDate	7/16/2022
CertificateExpirationDate	7/15/2024
FacilityType	PPMP

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