05D2157492 CLIA NUMBER - ARCHANGEL HOSPICE, LLC

Laboratory Demographics

  • CLIA Code: 05D2157492
  • Facility Name: ARCHANGEL HOSPICE, LLC
  • Facility Address: 57475 TWENTYNINE PALMS HIGHWAY SUITE 103
    YUCCA VALLEY, CA
    ZIP 92284
  • Facility Phone: 760 820-1742
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: NINA K. MAW MAW MD
  • NPI Number: 1629554977
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2157492
LAB Type Hospice
Facility Name ARCHANGEL HOSPICE, LLC
Street 57475 TWENTYNINE PALMS HIGHWAY SUITE 103
City YUCCA VALLEY
State CA
ZIP 92284
Phone 760 820-1742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Hospice
Lab Director NINA K. MAW MAW MD

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