05D2029541 CLIA NUMBER - PREMIUM HOSPICE INC

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Laboratory Demographics

CLIA Number: 05D2029541

Facility Name: PREMIUM HOSPICE INC

Facility Address:
12241 FIRESTONE BLVD STE A & B
NORWALK, CA
ZIP 90650
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Facility Phone Number: 562 929-7221

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1063712214

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2029541
LAB Type	Hospice
Facility Name	PREMIUM HOSPICE INC
Street	12241 FIRESTONE BLVD STE A & B
City	NORWALK
State	CA
ZIP	90650
Phone	562 929-7221
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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