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05D2108929 CLIA NUMBER - MISSION HOME HEALTH OF ONTARIO, INC

Laboratory Demographics

CLIA Number: 05D2108929

Facility Name: MISSION HOME HEALTH OF ONTARIO, INC

Facility Address:
901 VIA PIEMONTE SUITE 100
ONTARIO, CA
ZIP 91764
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Facility Phone Number: 909 980-3010

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1528450475

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 05D2108929
LAB Type Home Health Agency
Facility Name MISSION HOME HEALTH OF ONTARIO, INC
Street 901 VIA PIEMONTE SUITE 100
City ONTARIO
State CA
ZIP 91764
Phone 909 980-3010
CertificateType 4
CertificateEffectiveDate 2/16/2024
CertificateExpirationDate 2/15/2026
FacilityType Waiver

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