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05D0642863 CLIA NUMBER - PILGRIM PLACE HEALTH SERVICES CENTER

Laboratory Demographics

CLIA Number: 05D0642863

Facility Name: PILGRIM PLACE HEALTH SERVICES CENTER

Facility Address:
721 W HARRISON AVE
CLAREMONT, CA
ZIP 91711
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Facility Phone Number: 909 399-5592

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1114076601

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name Field Value
CLIA Number 05D0642863
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PILGRIM PLACE HEALTH SERVICES CENTER
Street 721 W HARRISON AVE
City CLAREMONT
State CA
ZIP 91711
Phone 909 399-5592
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024