05D0698426 CLIA NUMBER - AG WEST COVINA DBA COUNTRY VILLA WEST COVINA HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 05D0698426
  • Facility Name: AG WEST COVINA DBA COUNTRY VILLA WEST COVINA HEALTHCARE CENTER
  • Facility Address: 850 SOUTH SUNKIST AVENUE
    WEST COVINA, CA
    ZIP 91790
  • Facility Phone: 626 962-3368
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SANJAY KHEDIA, MD
  • NPI Number: 1326032814
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0698426
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AG WEST COVINA DBA COUNTRY VILLA WEST COVINA HEALTHCARE CENTER
Street 850 SOUTH SUNKIST AVENUE
City WEST COVINA
State CA
ZIP 91790
Phone 626 962-3368
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 SANJAY KHEDIA, MD

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