05D2145223 CLIA NUMBER - GRAND VILLA CONGREGATE LIVING HEALTH FACILITY

Laboratory Demographics

  • CLIA Code: 05D2145223
  • Facility Name: GRAND VILLA CONGREGATE LIVING HEALTH FACILITY
  • Facility Address: 250 VILLA AVE
    CLOVIS, CA
    ZIP 93612
  • Facility Phone: 559 273-1706
  • Facility Type: Other - CONGREGATE LVL HLTH FACIL
  • Facility Type: Waiver
  • Lab Director: BEN RAD, MD
  • NPI Number: 1326595117
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2145223
LAB Type Other - CONGREGATE LVL HLTH FACIL
Facility Name GRAND VILLA CONGREGATE LIVING HEALTH FACILITY
Street 250 VILLA AVE
City CLOVIS
State CA
ZIP 93612
Phone 559 273-1706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Other - CONGREGATE LVL HLTH FACIL
Lab Director BEN RAD, MD

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