05D2105340 CLIA NUMBER - SERENITY HOSPICE CARE PROVIDER INC

Laboratory Demographics

CLIA Number: 05D2105340

Facility Name: SERENITY HOSPICE CARE PROVIDER INC

Facility Address:
2139 TAPO ST STE 225
SIMI VALLEY, CA
ZIP 93063
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Facility Phone Number: 805 522-5506

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1003212010

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2105340
LAB Type	Hospice
Facility Name	SERENITY HOSPICE CARE PROVIDER INC
Street	2139 TAPO ST STE 225
City	SIMI VALLEY
State	CA
ZIP	93063
Phone	805 522-5506
CertificateType	4
CertificateEffectiveDate	11/23/2023
CertificateExpirationDate	11/22/2025
FacilityType	Waiver

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