05D2302442 CLIA NUMBER - VIVAT SKILLED NURSING, INC

Laboratory Demographics

  • CLIA Code: 05D2302442
  • Facility Name: VIVAT SKILLED NURSING, INC
  • Facility Address: 411 N CENTRAL AVE STE 302
    GLENDALE, CA
    ZIP 91203
  • Facility Phone: 213 477-4447
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: ROBBY T. AYOUB
  • NPI Number: 1043778343
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2302442
LAB Type Home Health Agency
Facility Name VIVAT SKILLED NURSING, INC
Street 411 N CENTRAL AVE STE 302
City GLENDALE
State CA
ZIP 91203
Phone 213 477-4447
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2024
Certificate Expiration Date 4/9/2026
Facility Type Home Health Agency
Lab Director ROBBY T. AYOUB

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