05D0963450 CLIA NUMBER - MESA GLEN CARE CENTER

Laboratory Demographics

  • CLIA Code: 05D0963450
  • Facility Name: MESA GLEN CARE CENTER
  • Facility Address: 638 EAST COLORADO BLVD
    GLENDORA, CA
    ZIP 91740
  • Facility Phone: 626 963-6091
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: WILLIAM TSAI
  • NPI Number: 1932215100
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0963450
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MESA GLEN CARE CENTER
Street 638 EAST COLORADO BLVD
City GLENDORA
State CA
ZIP 91740
Phone 626 963-6091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2025
Certificate Expiration Date 7/28/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director WILLIAM TSAI

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