05D2203465 CLIA NUMBER - ANGENIDA HOSPICE LLC

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Laboratory Demographics

CLIA Number: 05D2203465

Facility Name: ANGENIDA HOSPICE LLC

Facility Address:
14081 YORBA STREET SUITE 201
TUSTIN, CA
ZIP 92780
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Facility Phone Number: 714 442-3853

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1669008934

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2203465
LAB Type	Hospice
Facility Name	ANGENIDA HOSPICE LLC
Street	14081 YORBA STREET SUITE 201
City	TUSTIN
State	CA
ZIP	92780
Phone	714 442-3853
CertificateType	4
CertificateEffectiveDate	12/3/2022
CertificateExpirationDate	12/2/2024
FacilityType	Waiver

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