05D2026421 CLIA NUMBER - TARA DIVISION

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CLIA Record

Field Name Field Value
CLIA Number 05D2026421
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name TARA DIVISION
Street 1695 ROSENA AVE
City LOMA LINDA
State CA
ZIP 92354
Phone 909 796-0629
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director SHARON RIESEN

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