05D2167557 CLIA NUMBER - LOS ROBLES HEALTHCARE

Laboratory Demographics

CLIA Number: 05D2167557

Facility Name: LOS ROBLES HEALTHCARE

Facility Address:
1720 E GARRY STREET, SUITE 120
SANTA ANA, CA
ZIP 92705
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Facility Phone Number: 310 782-1177

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1538598131

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2167557
LAB Type	Hospice
Facility Name	LOS ROBLES HEALTHCARE
Street	1720 E GARRY STREET, SUITE 120
City	SANTA ANA
State	CA
ZIP	92705
Phone	310 782-1177
CertificateType	4
CertificateEffectiveDate	6/11/2023
CertificateExpirationDate	6/10/2025
FacilityType	Waiver

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