05D0718873 CLIA NUMBER - AG SAN GABRIEL LLC DBA BROADWAY HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 05D0718873
  • Facility Name: AG SAN GABRIEL LLC DBA BROADWAY HEALTHCARE CENTER
  • Facility Address: 112 E BROADWAY
    SAN GABRIEL, CA
    ZIP 91776
  • Facility Phone: 626 285-2165
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: OSCAR L. CHIEN
  • NPI Number: 1477547024
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0718873
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AG SAN GABRIEL LLC DBA BROADWAY HEALTHCARE CENTER
Street 112 E BROADWAY
City SAN GABRIEL
State CA
ZIP 91776
Phone 626 285-2165
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 OSCAR L. CHIEN

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