05D2270998 CLIA NUMBER - ELICA HEALTH CENTERS - GLENDALE

Laboratory Demographics

CLIA Number: 05D2270998

Facility Name: ELICA HEALTH CENTERS - GLENDALE

Facility Address:
2400 GLENDALE LN
SACRAMENTO, CA
ZIP 95825
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Facility Phone Number: 916 454-2345

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1790419059

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2270998
LAB Type	Federally Qualified Health Center
Facility Name	ELICA HEALTH CENTERS - GLENDALE
Street	2400 GLENDALE LN
City	SACRAMENTO
State	CA
ZIP	95825
Phone	916 454-2345
CertificateType	4
CertificateEffectiveDate	10/25/2022
CertificateExpirationDate	10/24/2024
FacilityType	Waiver

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