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05D0726097 CLIA NUMBER - CALIFORNIA CONVALESCENT CENTER #1

Laboratory Demographics

CLIA Number: 05D0726097

Facility Name: CALIFORNIA CONVALESCENT CENTER #1

Facility Address:
909 SOUTH LAKE STREET
LOS ANGELES, CA
ZIP 90006
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Facility Phone Number: 213 385-7301

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1194877324

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name Field Value
CLIA Number 05D0726097
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CALIFORNIA CONVALESCENT CENTER #1
Street 909 SOUTH LAKE STREET
City LOS ANGELES
State CA
ZIP 90006
Phone 213 385-7301
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