05D0558587 CLIA NUMBER - COUNTRY MANOR HEALTHCARE

Laboratory Demographics

  • CLIA Code: 05D0558587
  • Facility Name: COUNTRY MANOR HEALTHCARE
  • Facility Address: 11723 FENTON AVE
    LAKE VIEW TERRACE, CA
    ZIP 91342
  • Facility Phone: 818 899-0251
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KINGSLEY OFOEGBU
  • NPI Number: 1790766376
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0558587
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name COUNTRY MANOR HEALTHCARE
Street 11723 FENTON AVE
City LAKE VIEW TERRACE
State CA
ZIP 91342
Phone 818 899-0251
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 KINGSLEY OFOEGBU

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