05D2256612 CLIA NUMBER - SEBASTOPOL FAMILY PHARMACY, INC

Laboratory Demographics

CLIA Number: 05D2256612

Facility Name: SEBASTOPOL FAMILY PHARMACY, INC

Facility Address:
652 PETALUMA AVENUE, SUITE I-1
SEBASTOPOL, CA
ZIP 95472
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Facility Phone Number: 707 824-1876

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1568459147

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	05D2256612
LAB Type	Pharmacy
Facility Name	SEBASTOPOL FAMILY PHARMACY, INC
Street	652 PETALUMA AVENUE, SUITE I-1
City	SEBASTOPOL
State	CA
ZIP	95472
Phone	707 824-1876
CertificateType	4
CertificateEffectiveDate	3/25/2024
CertificateExpirationDate	3/24/2026
FacilityType	Waiver

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