05D2284579 CLIA NUMBER - LIGHTFULLY BEHAVIORAL HEALTH - ILLUMINATE

Laboratory Demographics

CLIA Code: 05D2284579
Facility Name: LIGHTFULLY BEHAVIORAL HEALTH - ILLUMINATE
Facility Address: 1013 HUDSON ST
REDWOOD CITY, CA
ZIP 94061
Facility Phone: 818 483-0865
Facility Type: Skilled Nursing Facility/Nursing Facility
Facility Type: Waiver
Lab Director: KATHRYN HIRST
NPI Number: 1528842713
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2284579
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	LIGHTFULLY BEHAVIORAL HEALTH - ILLUMINATE
Street	1013 HUDSON ST
City	REDWOOD CITY
State	CA
ZIP	94061
Phone	818 483-0865
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/26/2025
Certificate Expiration Date	6/25/2027
Facility Type	Skilled Nursing Facility/Nursing Facility
Lab Director	KATHRYN HIRST

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This page was last updated on: 9/29/2025