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05D2078281 CLIA NUMBER - PREMIER HEALTHCARE SERVICES LLC

Laboratory Demographics

CLIA Number: 05D2078281

Facility Name: PREMIER HEALTHCARE SERVICES LLC

Facility Address:
12401 HESPERIA RD, STE 8
VICTORVILLE, CA
ZIP 92395
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Facility Phone Number: 442 300-9788

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1295159366

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 05D2078281
LAB Type Home Health Agency
Facility Name PREMIER HEALTHCARE SERVICES LLC
Street 12401 HESPERIA RD, STE 8
City VICTORVILLE
State CA
ZIP 92395
Phone 442 300-9788
CertificateType 4
CertificateEffectiveDate 5/23/2022
CertificateExpirationDate 5/22/2024
FacilityType Waiver

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