05D2326693 CLIA NUMBER - EVERGREEN CONGREGATE

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CLIA Record

Field Name Field Value
CLIA Number 05D2326693
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVERGREEN CONGREGATE
Street 823 TOWNE ST
City COSTA MESA
State CA
ZIP 92627
Phone 949 343-0464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LUTHER MANGOBA

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