05D0574080 CLIA NUMBER - PLYMOUTH VILLAGE

Laboratory Demographics

  • CLIA Code: 05D0574080
  • Facility Name: PLYMOUTH VILLAGE
  • Facility Address: 819 SALEM DRIVE
    REDLANDS, CA
    ZIP 92373
  • Facility Phone: 909 793-1233
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MOHAMED NASSAR
  • NPI Number: 1578550372
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0574080
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PLYMOUTH VILLAGE
Street 819 SALEM DRIVE
City REDLANDS
State CA
ZIP 92373
Phone 909 793-1233
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 MOHAMED NASSAR

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This page was last updated on: 3/20/2025