05D0666301 CLIA NUMBER - GARDEN GROVE CONVALESCENT

Laboratory Demographics

  • CLIA Code: 05D0666301
  • Facility Name: GARDEN GROVE CONVALESCENT
  • Facility Address: 12882 SHACKELFORD LANE
    GARDEN GROVE, CA
    ZIP 92841
  • Facility Phone: 714 638-9470
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. DAT Q. NGUYEN
  • NPI Number: 1497903868
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0666301
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GARDEN GROVE CONVALESCENT
Street 12882 SHACKELFORD LANE
City GARDEN GROVE
State CA
ZIP 92841
Phone 714 638-9470
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 DR. DAT Q. NGUYEN

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This page was last updated on: 6/4/2025