05D2162644 CLIA NUMBER - ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE, INC

Laboratory Demographics

  • CLIA Code: 05D2162644
  • Facility Name: ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE, INC
  • Facility Address: 1505 WEST AVE J, STE 303
    LANCASTER, CA
    ZIP 93534
  • Facility Phone: 661 247-8345
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: DANIEL B. KHODABAKHSH
  • NPI Number: 1225436967
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2162644
LAB Type Hospice
Facility Name ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE, INC
Street 1505 WEST AVE J, STE 303
City LANCASTER
State CA
ZIP 93534
Phone 661 247-8345
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Hospice
Lab Director DANIEL B. KHODABAKHSH

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