05D2301246 CLIA NUMBER - LIGHT ANGEL HOSPICE INC

Laboratory Demographics

  • CLIA Code: 05D2301246
  • Facility Name: LIGHT ANGEL HOSPICE INC
  • Facility Address: 13609 VICTORY BLVD #236
    VAN NUYS, CA
    ZIP 91401
  • Facility Phone: 747 208-4477
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: GOHAR GEVORGYAN
  • NPI Number: 1033651096
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2301246
LAB Type Hospital
Facility Name LIGHT ANGEL HOSPICE INC
Street 13609 VICTORY BLVD #236
City VAN NUYS
State CA
ZIP 91401
Phone 747 208-4477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Hospital
Lab Director GOHAR GEVORGYAN

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