03D2121395 CLIA NUMBER - ETERNITY HOSPICE & PALLIATIVE CARE, PLLC

Laboratory Demographics

  • CLIA Code: 03D2121395
  • Facility Name: ETERNITY HOSPICE & PALLIATIVE CARE, PLLC
  • Facility Address: 4140 N 108TH AVE, SUITE 101A
    PHOENIX, AZ
    ZIP 85037
  • Facility Phone: 602 374-6878
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: AMABEL BONGOYAN
  • NPI Number: 1396140778
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 03D2121395
LAB Type Hospice
Facility Name ETERNITY HOSPICE & PALLIATIVE CARE, PLLC
Street 4140 N 108TH AVE, SUITE 101A
City PHOENIX
State AZ
ZIP 85037
Phone 602 374-6878
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2024
Certificate Expiration Date 11/2/2026
Facility Type Hospice
Lab Director AMABEL BONGOYAN

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This page was last updated on: 6/4/2025