05D2087596 CLIA NUMBER - GRAND TERRACE HOSPICE

Laboratory Demographics

  • CLIA Code: 05D2087596
  • Facility Name: GRAND TERRACE HOSPICE
  • Facility Address: 22737 BARTON RD STE 11
    GRAND TERRACE, CA
    ZIP 92313
  • Facility Phone: 323 440-4647
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: RAVINDRANATH V. SHAHANE, MD
  • NPI Number: 1659791721
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2087596
LAB Type Hospice
Facility Name GRAND TERRACE HOSPICE
Street 22737 BARTON RD STE 11
City GRAND TERRACE
State CA
ZIP 92313
Phone 323 440-4647
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Hospice
Lab Director RAVINDRANATH V. SHAHANE, MD

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This page was last updated on: 3/20/2025