05D2078742 CLIA NUMBER - BRIDGE HOSPICE, LLC

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Laboratory Demographics

CLIA Number: 05D2078742

Facility Name: BRIDGE HOSPICE, LLC

Facility Address:
5090 SHOREHAM PL, STE 212
SAN DIEGO, CA
ZIP 92122
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Facility Phone Number: 858 277-5200

Facility Type: Insurance

Certificate Type: Waiver

NPI Number: 1891353124

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2078742
LAB Type	Insurance
Facility Name	BRIDGE HOSPICE, LLC
Street	5090 SHOREHAM PL, STE 212
City	SAN DIEGO
State	CA
ZIP	92122
Phone	858 277-5200
CertificateType	4
CertificateEffectiveDate	6/3/2022
CertificateExpirationDate	6/2/2024
FacilityType	Waiver

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