05D2320844 CLIA NUMBER - ANTIOCH ICF INC DBA PUTNAM WEST ICF/DDN

Laboratory Demographics

  • CLIA Code: 05D2320844
  • Facility Name: ANTIOCH ICF INC DBA PUTNAM WEST ICF/DDN
  • Facility Address: 1228 PUTNAM ST
    ANTIOCH, CA
    ZIP 94509
  • Facility Phone: 650 216-9960
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ROSEMARIE VERIDIANO
  • NPI Number: 1083832752
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 05D2320844
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name ANTIOCH ICF INC DBA PUTNAM WEST ICF/DDN
Street 1228 PUTNAM ST
City ANTIOCH
State CA
ZIP 94509
Phone 650 216-9960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ROSEMARIE VERIDIANO

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