05D2286538 CLIA NUMBER - LEGACY CARE HOSPICE INC DBA SUNCREST HOSPICE CARE

Laboratory Demographics

  • CLIA Code: 05D2286538
  • Facility Name: LEGACY CARE HOSPICE INC DBA SUNCREST HOSPICE CARE
  • Facility Address: 36923 COOK ST, STE 102-1
    PALM DESERT, CA
    ZIP 92211
  • Facility Phone: 347 355-4164
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: JOHANN G. GRAY
  • NPI Number: 1396209268
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2286538
LAB Type Hospice
Facility Name LEGACY CARE HOSPICE INC DBA SUNCREST HOSPICE CARE
Street 36923 COOK ST, STE 102-1
City PALM DESERT
State CA
ZIP 92211
Phone 347 355-4164
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2025
Certificate Expiration Date 7/30/2027
Facility Type Hospice
Lab Director JOHANN G. GRAY

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