05D2188940 CLIA NUMBER - LIGHT HOSPICE INC

Laboratory Demographics

  • CLIA Code: 05D2188940
  • Facility Name: LIGHT HOSPICE INC
  • Facility Address: 13615 VICTORY BLVD STE 112
    VAN NUYS, CA
    ZIP 91401
  • Facility Phone: 818 538-5538
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: GOHAR GEVORGYAN
  • NPI Number: 1780223008
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2188940
LAB Type Hospice
Facility Name LIGHT HOSPICE INC
Street 13615 VICTORY BLVD STE 112
City VAN NUYS
State CA
ZIP 91401
Phone 818 538-5538
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Hospice
Lab Director GOHAR GEVORGYAN

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