05D1072531 CLIA NUMBER - CARE PROVIDER HOME HEALTH INC DBA A FLYING EAGLE HOME HEALTH

Laboratory Demographics

CLIA Number: 05D1072531

Facility Name: CARE PROVIDER HOME HEALTH INC DBA A FLYING EAGLE HOME HEALTH

Facility Address:
2775 TAPO ST, #101
SIMI VALLEY, CA
ZIP 93063
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Facility Phone Number: 805 582-9389

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1144437641

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	05D1072531
LAB Type	Home Health Agency
Facility Name	CARE PROVIDER HOME HEALTH INC DBA A FLYING EAGLE HOME HEALTH
Street	2775 TAPO ST, #101
City	SIMI VALLEY
State	CA
ZIP	93063
Phone	805 582-9389
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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