05D2076941 CLIA NUMBER - FAMILY HERITAGE HOME HEALTH

Laboratory Demographics

  • CLIA Code: 05D2076941
  • Facility Name: FAMILY HERITAGE HOME HEALTH
  • Facility Address: 1126 FOOTHILL BLVD STE 225
    UPLAND, CA
    ZIP 91786
  • Facility Phone: 909 920-6885
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: JOEL PENGSON
  • NPI Number: 1780027342
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2076941
LAB Type Home Health Agency
Facility Name FAMILY HERITAGE HOME HEALTH
Street 1126 FOOTHILL BLVD STE 225
City UPLAND
State CA
ZIP 91786
Phone 909 920-6885
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2024
Certificate Expiration Date 4/28/2026
Facility Type Home Health Agency
Lab Director JOEL PENGSON

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