05D0643959 CLIA NUMBER - WILLOW GLEN CONVALESCENT HOSPITAL

Laboratory Demographics

  • CLIA Code: 05D0643959
  • Facility Name: WILLOW GLEN CONVALESCENT HOSPITAL
  • Facility Address: 1267 MERIDIAN AVENUE
    SAN JOSE, CA
    ZIP 95125
  • Facility Phone: 408 265-4211
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ALICE K. MAU
  • NPI Number: 1083788079
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0643959
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name WILLOW GLEN CONVALESCENT HOSPITAL
Street 1267 MERIDIAN AVENUE
City SAN JOSE
State CA
ZIP 95125
Phone 408 265-4211
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 ALICE K. MAU

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