05D0878929 CLIA NUMBER - IMPERIAL MANOR SKILLED NURSING, INC DBA IMPERIAL MANOR

Laboratory Demographics

  • CLIA Code: 05D0878929
  • Facility Name: IMPERIAL MANOR SKILLED NURSING, INC DBA IMPERIAL MANOR
  • Facility Address: 100 E SECOND ST
    IMPERIAL, CA
    ZIP 92251
  • Facility Phone: 760 355-2858
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TIEN T. VO, MD
  • NPI Number: 1437668720
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0878929
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name IMPERIAL MANOR SKILLED NURSING, INC DBA IMPERIAL MANOR
Street 100 E SECOND ST
City IMPERIAL
State CA
ZIP 92251
Phone 760 355-2858
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TIEN T. VO, MD

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