05D2068002 CLIA NUMBER - MIRACLE MILE HOSPICE CARE INC

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Laboratory Demographics

CLIA Number: 05D2068002

Facility Name: MIRACLE MILE HOSPICE CARE INC

Facility Address:
5670 WLSHIRE BLD, STE 1600A
LOS ANGELES, CA
ZIP 90036
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Facility Phone Number: 323 951-0880

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1801221049

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2068002
LAB Type	Hospice
Facility Name	MIRACLE MILE HOSPICE CARE INC
Street	5670 WLSHIRE BLD, STE 1600A
City	LOS ANGELES
State	CA
ZIP	90036
Phone	323 951-0880
CertificateType	4
CertificateEffectiveDate	10/25/2023
CertificateExpirationDate	10/24/2025
FacilityType	Waiver

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