05D2163100 CLIA NUMBER - ALLY HOSPICE CORPORATION

Laboratory Demographics

  • CLIA Code: 05D2163100
  • Facility Name: ALLY HOSPICE CORPORATION
  • Facility Address: 202 E AIRPORT DRIVE, #240
    SAN BERNARDINO, CA
    ZIP 92408
  • Facility Phone: 909 381-4400
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: GIMHA GUNAWARDANA
  • NPI Number: 1346764776
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2163100
LAB Type Hospice
Facility Name ALLY HOSPICE CORPORATION
Street 202 E AIRPORT DRIVE, #240
City SAN BERNARDINO
State CA
ZIP 92408
Phone 909 381-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2025
Certificate Expiration Date 3/6/2027
Facility Type Hospice
Lab Director GIMHA GUNAWARDANA

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