05D2056691 CLIA NUMBER - BLACK MOUNTAIN HEALTHCARE LLC DBA SEAPORT HOSPICE

Laboratory Demographics

  • CLIA Code: 05D2056691
  • Facility Name: BLACK MOUNTAIN HEALTHCARE LLC DBA SEAPORT HOSPICE
  • Facility Address: 3750 CONVOY STREET, SUITE 220B
    SAN DIEGO, CA
    ZIP 92111
  • Facility Phone: 858 634-5870
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: ROBERT DEMONTE
  • NPI Number: 1265837405
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2056691
LAB Type Hospice
Facility Name BLACK MOUNTAIN HEALTHCARE LLC DBA SEAPORT HOSPICE
Street 3750 CONVOY STREET, SUITE 220B
City SAN DIEGO
State CA
ZIP 92111
Phone 858 634-5870
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2025
Certificate Expiration Date 4/1/2027
Facility Type Hospice
Lab Director ROBERT DEMONTE

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