05D1015268 CLIA NUMBER - GRACE HOSPICE INC

Laboratory Demographics

CLIA Number: 05D1015268

Facility Name: GRACE HOSPICE INC

Facility Address:
1711 WEST TEMPLE STREET SUITE #3614
LOS ANGELES, CA
ZIP 90026
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Facility Phone Number: 213 989-1600

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1588722771

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D1015268
LAB Type	Hospice
Facility Name	GRACE HOSPICE INC
Street	1711 WEST TEMPLE STREET SUITE #3614
City	LOS ANGELES
State	CA
ZIP	90026
Phone	213 989-1600
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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