05D2107459 CLIA NUMBER - AFFECTIVE HOSPICE CARE, INC

Laboratory Demographics

CLIA Number: 05D2107459

Facility Name: AFFECTIVE HOSPICE CARE, INC

Facility Address:
5050 PALO VERDE ST STE 208
MONTCLAIR, CA
ZIP 91763
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Facility Phone Number: 909 962-7488

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1548645302

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2107459
LAB Type	Hospice
Facility Name	AFFECTIVE HOSPICE CARE, INC
Street	5050 PALO VERDE ST STE 208
City	MONTCLAIR
State	CA
ZIP	91763
Phone	909 962-7488
CertificateType	4
CertificateEffectiveDate	1/14/2024
CertificateExpirationDate	1/13/2026
FacilityType	Waiver

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