05D0725547 CLIA NUMBER - PASADENA GROVE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D0725547
  • Facility Name: PASADENA GROVE HEALTH CENTER
  • Facility Address: 1470 NORTH FAIR OAKS AVENUE
    PASADENA, CA
    ZIP 91103
  • Facility Phone: 626 798-9133
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ROY H. JACKSON
  • NPI Number: 1629470927
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0725547
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PASADENA GROVE HEALTH CENTER
Street 1470 NORTH FAIR OAKS AVENUE
City PASADENA
State CA
ZIP 91103
Phone 626 798-9133
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 ROY H. JACKSON

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