05D0694228 CLIA NUMBER - GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME

Laboratory Demographics

CLIA Number: 05D0694228

Facility Name: GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME

Facility Address:
7150 TAMPA AVE
RESEDA, CA
ZIP 91335
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Facility Phone Number: 818 774-3000

Facility Type: Other - HOSPITAL DPSNF/SNF

Certificate Type: Waiver

NPI Number: 1518177021

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	05D0694228
LAB Type	Other - HOSPITAL DPSNF/SNF
Facility Name	GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME
Street	7150 TAMPA AVE
City	RESEDA
State	CA
ZIP	91335
Phone	818 774-3000
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