05D2300112 CLIA NUMBER - MEDICUS COMMUNITY HOME HEALTH

Laboratory Demographics

  • CLIA Code: 05D2300112
  • Facility Name: MEDICUS COMMUNITY HOME HEALTH
  • Facility Address: 16555A GAULT STREET
    VAN NUYS, CA
    ZIP 91406
  • Facility Phone: 818 922-2891
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: STEPHEN N. PINE
  • NPI Number: 1215522123
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2300112
LAB Type Home Health Agency
Facility Name MEDICUS COMMUNITY HOME HEALTH
Street 16555A GAULT STREET
City VAN NUYS
State CA
ZIP 91406
Phone 818 922-2891
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Home Health Agency
Lab Director STEPHEN N. PINE

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