05D2032676 CLIA NUMBER - EMMANUEL HOSPICE, INC

Laboratory Demographics

  • CLIA Code: 05D2032676
  • Facility Name: EMMANUEL HOSPICE, INC
  • Facility Address: 4640 LANKERSHIM BLVD STE 110
    NORTH HOLLYWOOD, CA
    ZIP 91602
  • Facility Phone: 818 763-2728
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: VIOLETA VICENCIO MD
  • NPI Number: 1831485408
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2032676
LAB Type Hospice
Facility Name EMMANUEL HOSPICE, INC
Street 4640 LANKERSHIM BLVD STE 110
City NORTH HOLLYWOOD
State CA
ZIP 91602
Phone 818 763-2728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Hospice
Lab Director VIOLETA VICENCIO MD

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