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05D0979182 CLIA NUMBER - STAFF ASSISTANCE/ASSISTED HEALTHCARE SERVICE

Laboratory Demographics

CLIA Number: 05D0979182

Facility Name: STAFF ASSISTANCE/ASSISTED HEALTHCARE SERVICE

Facility Address:
1900 W GARVEY AVE S
WEST COVINA, CA
ZIP 91790
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Facility Phone Number: 626 915-5595

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1851344717

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 05D0979182
LAB Type Home Health Agency
Facility Name STAFF ASSISTANCE/ASSISTED HEALTHCARE SERVICE
Street 1900 W GARVEY AVE S
City WEST COVINA
State CA
ZIP 91790
Phone 626 915-5595
CertificateType 4
CertificateEffectiveDate 8/1/2022
CertificateExpirationDate 7/31/2024
FacilityType Waiver

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