05D0609905 CLIA NUMBER - GRACE HOME

Laboratory Demographics

  • CLIA Code: 05D0609905
  • Facility Name: GRACE HOME
  • Facility Address: 13435 W PEACH AVE
    LIVINGSTON, CA
    ZIP 95334
  • Facility Phone: 209 394-2440
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NANDEESH VEERAPPA
  • NPI Number: 1750368387
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0609905
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GRACE HOME
Street 13435 W PEACH AVE
City LIVINGSTON
State CA
ZIP 95334
Phone 209 394-2440
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 NANDEESH VEERAPPA

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