05D2190145 CLIA NUMBER - MAYANE CONGREGATE LIVING

Laboratory Demographics

  • CLIA Code: 05D2190145
  • Facility Name: MAYANE CONGREGATE LIVING
  • Facility Address: 17227 SIMONDS STREET
    GRANADA HILLS, CA
    ZIP 91344
  • Facility Phone: 818 488-1982
  • Facility Type: Other - CLHF
  • Facility Type: Waiver
  • Lab Director: SUMAN PATEL
  • NPI Number: 1194231605
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2190145
LAB Type Other - CLHF
Facility Name MAYANE CONGREGATE LIVING
Street 17227 SIMONDS STREET
City GRANADA HILLS
State CA
ZIP 91344
Phone 818 488-1982
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Other - CLHF
Lab Director SUMAN PATEL

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