05D2168918 CLIA NUMBER - AUTHENTIC HOME HEALTH, INC

Laboratory Demographics

CLIA Number: 05D2168918

Facility Name: AUTHENTIC HOME HEALTH, INC

Facility Address:
2667 N MOOREPARK ROAD, SUITE 203
THOUSAND OAKS, CA
ZIP 91360
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Facility Phone Number: 805 241-4411

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1043773039

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	05D2168918
LAB Type	Hospice
Facility Name	AUTHENTIC HOME HEALTH, INC
Street	2667 N MOOREPARK ROAD, SUITE 203
City	THOUSAND OAKS
State	CA
ZIP	91360
Phone	805 241-4411
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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