05D0891550 CLIA NUMBER - MOUNTAIN MANOR

Laboratory Demographics

  • CLIA Code: 05D0891550
  • Facility Name: MOUNTAIN MANOR
  • Facility Address: 6101 FAIR OAKS BLVD
    CARMICHAEL, CA
    ZIP 95608
  • Facility Phone: 916 488-7211
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOHN LOFTUS
  • NPI Number: 1538251657
  • Taxonomy: 311Z00000X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0891550
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MOUNTAIN MANOR
Street 6101 FAIR OAKS BLVD
City CARMICHAEL
State CA
ZIP 95608
Phone 916 488-7211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JOHN LOFTUS

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