03D1078946 CLIA NUMBER - LITCHFIELD COUNTRYSIDE HOME CARE, LLC

Laboratory Demographics

  • CLIA Code: 03D1078946
  • Facility Name: LITCHFIELD COUNTRYSIDE HOME CARE, LLC
  • Facility Address: 3333 N 188TH AVE
    LITCHFIELD PARK, AZ
    ZIP 85340
  • Facility Phone: 623 505-4728
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: MIRELA M. NICULCEA
  • NPI Number: 1144683061
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 03D1078946
LAB Type Other
Facility Name LITCHFIELD COUNTRYSIDE HOME CARE, LLC
Street 3333 N 188TH AVE
City LITCHFIELD PARK
State AZ
ZIP 85340
Phone 623 505-4728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2024
Certificate Expiration Date 1/17/2026
Facility Type Other
Lab Director MIRELA M. NICULCEA

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