05D1067173 CLIA NUMBER - IMPERIAL HOME HEALTH

Laboratory Demographics

  • CLIA Code: 05D1067173
  • Facility Name: IMPERIAL HOME HEALTH
  • Facility Address: 16484 VICTOR STREET
    VICTORVILLE, CA
    ZIP 92395
  • Facility Phone: 760 951-6688
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: SHIMA HADIDCHI
  • NPI Number: 1104067578
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D1067173
LAB Type Home Health Agency
Facility Name IMPERIAL HOME HEALTH
Street 16484 VICTOR STREET
City VICTORVILLE
State CA
ZIP 92395
Phone 760 951-6688
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Home Health Agency
Lab Director SHIMA HADIDCHI

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