05D1070883 CLIA NUMBER - MOONSTONE HOME

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Field Name	Field Value
CLIA Number	05D1070883
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MOONSTONE HOME
Street	2331 KNOLLHAVEN STREET
City	SIMI VALLEY
State	CA
ZIP	93065
Phone	805 527-1879
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/8/2024
Certificate Expiration Date	9/7/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ZIA ABDO M. MEMAR

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