05D2091121 CLIA NUMBER - SAINT JOHN HOSPICE

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Laboratory Demographics

CLIA Number: 05D2091121

Facility Name: SAINT JOHN HOSPICE

Facility Address:
1053 COLORADO BLVD STE F
LOS ANGELES, CA
ZIP 90041
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Facility Phone Number: 323 254-1100

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1497157796

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2091121
LAB Type	Hospice
Facility Name	SAINT JOHN HOSPICE
Street	1053 COLORADO BLVD STE F
City	LOS ANGELES
State	CA
ZIP	90041
Phone	323 254-1100
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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