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05D0886201 CLIA NUMBER - LAUREL PARK

Laboratory Demographics

CLIA Number: 05D0886201

Facility Name: LAUREL PARK

Facility Address:
1425 W LAUREL AVE
POMONA, CA
ZIP 91768
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Facility Phone Number: 909 622-1069

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1639126782

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 05D0886201
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAUREL PARK
Street 1425 W LAUREL AVE
City POMONA
State CA
ZIP 91768
Phone 909 622-1069
CertificateType 4
CertificateEffectiveDate 5/14/2024
CertificateExpirationDate 5/13/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024