03D2113499 CLIA NUMBER - ILITCHI HOME CARE, LLC

Laboratory Demographics

CLIA Number: 03D2113499

Facility Name: ILITCHI HOME CARE, LLC

Facility Address:
1345 E MAIN ST, STE 111
MESA, AZ
ZIP 85203
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Facility Phone Number: 480 580-3379

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1578919379

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	03D2113499
LAB Type	Home Health Agency
Facility Name	ILITCHI HOME CARE, LLC
Street	1345 E MAIN ST, STE 111
City	MESA
State	AZ
ZIP	85203
Phone	480 580-3379
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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