05D2297183 CLIA NUMBER - USRC LOS BANOS HOME, LLC US RENAL CARE LOS BANOS HOME PROGRAM

Laboratory Demographics

CLIA Number: 05D2297183

Facility Name: USRC LOS BANOS HOME, LLC US RENAL CARE LOS BANOS HOME PROGRAM

Facility Address:
1451 W PACHECO BLVD STE G
LOS BANOS, CA
ZIP 93635
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Facility Phone Number: 209 774-4211

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1972287605

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2297183
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC LOS BANOS HOME, LLC US RENAL CARE LOS BANOS HOME PROGRAM
Street	1451 W PACHECO BLVD STE G
City	LOS BANOS
State	CA
ZIP	93635
Phone	209 774-4211
CertificateType	4
CertificateEffectiveDate	1/11/2024
CertificateExpirationDate	1/10/2026
FacilityType	Waiver

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