05D2266456 CLIA NUMBER - ST GRACE HOSPICE HOUSE

Laboratory Demographics

  • CLIA Code: 05D2266456
  • Facility Name: ST GRACE HOSPICE HOUSE
  • Facility Address: 1351 5TH AVE
    UPLAND, CA
    ZIP 91786
  • Facility Phone: 909 577-0110
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ANOUSHEH ASHOURI
  • NPI Number: 1598809634
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2266456
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name ST GRACE HOSPICE HOUSE
Street 1351 5TH AVE
City UPLAND
State CA
ZIP 91786
Phone 909 577-0110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ANOUSHEH ASHOURI

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