05D2183516 CLIA NUMBER - GREEN PATH HOME HEALTH

Laboratory Demographics

CLIA Number: 05D2183516

Facility Name: GREEN PATH HOME HEALTH

Facility Address:
12158 HAMLIN ST SUITE 2
N HOLLYWOOD, CA
ZIP 91606
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Facility Phone Number: 818 331-1913

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1063079010

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	05D2183516
LAB Type	Home Health Agency
Facility Name	GREEN PATH HOME HEALTH
Street	12158 HAMLIN ST SUITE 2
City	N HOLLYWOOD
State	CA
ZIP	91606
Phone	818 331-1913
CertificateType	4
CertificateEffectiveDate	5/6/2024
CertificateExpirationDate	5/5/2026
FacilityType	Waiver

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