05D2142826 CLIA NUMBER - IMHOTEP, INC. DBA PRESIDENTIAL CARE HOME HEALTH

Laboratory Demographics

  • CLIA Code: 05D2142826
  • Facility Name: IMHOTEP, INC. DBA PRESIDENTIAL CARE HOME HEALTH
  • Facility Address: 337 N VINEYARD AVE STE 341
    ONTARIO, CA
    ZIP 91764
  • Facility Phone: 909 945-7087
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: LUTHER B. MANGOBA
  • NPI Number: 1134528342
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2142826
LAB Type Home Health Agency
Facility Name IMHOTEP, INC. DBA PRESIDENTIAL CARE HOME HEALTH
Street 337 N VINEYARD AVE STE 341
City ONTARIO
State CA
ZIP 91764
Phone 909 945-7087
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Home Health Agency
Lab Director LUTHER B. MANGOBA

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This page was last updated on: 9/29/2025