05D2204623 CLIA NUMBER - LIVING ANGELS HOSPICE CARE

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Laboratory Demographics

CLIA Number: 05D2204623

Facility Name: LIVING ANGELS HOSPICE CARE

Facility Address:
4959 PALO VERDE ST STE 208C-1
MONTCLAIR, CA
ZIP 91763
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Facility Phone Number: 909 675-7055

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1376160358

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2204623
LAB Type	Hospice
Facility Name	LIVING ANGELS HOSPICE CARE
Street	4959 PALO VERDE ST STE 208C-1
City	MONTCLAIR
State	CA
ZIP	91763
Phone	909 675-7055
CertificateType	4
CertificateEffectiveDate	12/9/2022
CertificateExpirationDate	12/8/2024
FacilityType	Waiver

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