05D2289563 CLIA NUMBER - WELLSPACE HEALTH BUNKER COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D2289563

Facility Name: WELLSPACE HEALTH BUNKER COMMUNITY HEALTH CENTER

Facility Address:
4990 STOCKTON BLVD
SACRAMENTO, CA
ZIP 95820
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Facility Phone Number: 916 737-5555

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1215702253

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2289563
LAB Type	Federally Qualified Health Center
Facility Name	WELLSPACE HEALTH BUNKER COMMUNITY HEALTH CENTER
Street	4990 STOCKTON BLVD
City	SACRAMENTO
State	CA
ZIP	95820
Phone	916 737-5555
CertificateType	4
CertificateEffectiveDate	9/12/2023
CertificateExpirationDate	9/11/2025
FacilityType	Waiver

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