03D2068745 CLIA NUMBER - MAGGIE'S HOSPICE, LLC

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Laboratory Demographics

CLIA Number: 03D2068745

Facility Name: MAGGIE'S HOSPICE, LLC

Facility Address:
306 N VIRGINIA ST
PRESCOTT, AZ
ZIP 86301
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Facility Phone Number: 928 775-2290

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1073854428

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	03D2068745
LAB Type	Hospice
Facility Name	MAGGIE'S HOSPICE, LLC
Street	306 N VIRGINIA ST
City	PRESCOTT
State	AZ
ZIP	86301
Phone	928 775-2290
CertificateType	4
CertificateEffectiveDate	11/12/2023
CertificateExpirationDate	11/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024