CLIA lab
CLIA 05D2121034: Provident Health Care Icf/Ddn
Atwater, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2121034 belongs to Provident Health Care Icf/Ddn in Atwater, CA.
Certificate of Waiver, effective October 28, 2024, expires October 27, 2026.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- October 28, 2024
- Certificate expiration
- October 27, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- October 28, 2016
- Facility type
- Intermediate care facility for individuals with intellectual disabilities
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D2121034
- Lab name
- Provident Health Care Icf/Ddn
- Address
- 1553 Tamarack St, Atwater, CA 95301
- Phone
- (209) 357-2212
- Fax
- (209) 357-5669
Annual test volume the lab reported
- Waived tests
- 720
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Bureau of Prisons-Us PenitentiaryCertificate of Waiver, Other05D0994338
- Carlos C Say MD IncCertificate for Provider-Performed Microscopy Procedures, Physician office05D0936201
- Castle Family Health Centers, IncCertificate for Provider-Performed Microscopy Procedures, Federally qualified health center05D0915793
- Castle Family Health Centers, Inc Urgent CareCertificate of Waiver, Federally qualified health center05D0953267
- Castle Family Health Centers, Inc at CastleCertificate of Compliance, Ancillary test site05D0900020
- Central California Surgery CenterCertificate of Waiver, Ambulatory surgery center05D2157596
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Related
Questions
What is the CLIA number for Provident Health Care Icf/Ddn in Atwater?
05D2121034, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Provident Health Care Icf/Ddn hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2121034 expire?
The CMS file lists October 27, 2026 as the certificate expiration date; the certificate took effect October 28, 2024.