05D1080121 CLIA NUMBER - RURAL HAVEN HOME

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Field Name	Field Value
CLIA Number	05D1080121
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	RURAL HAVEN HOME
Street	471 SARATOGA ST
City	FILLMORE
State	CA
ZIP	93015
Phone	805 520-3441
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/14/2024
Certificate Expiration Date	2/13/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ABDOL M. ZIA

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