05D0553694 CLIA NUMBER - AG SEAL BEACH DBA COUNTRY VILLA SEAL BEACH HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 05D0553694
  • Facility Name: AG SEAL BEACH DBA COUNTRY VILLA SEAL BEACH HEALTHCARE CENTER
  • Facility Address: 3000 BEVERLY MANOR ROAD
    SEAL BEACH, CA
    ZIP 90740
  • Facility Phone: 562 598-2477
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: RUDOLF HAIDER MD
  • NPI Number: 1699769182
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0553694
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AG SEAL BEACH DBA COUNTRY VILLA SEAL BEACH HEALTHCARE CENTER
Street 3000 BEVERLY MANOR ROAD
City SEAL BEACH
State CA
ZIP 90740
Phone 562 598-2477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director RUDOLF HAIDER MD

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