05D2304323 CLIA NUMBER - PROMED HEALTH PROVIDERS INC.

Laboratory Demographics

  • CLIA Code: 05D2304323
  • Facility Name: PROMED HEALTH PROVIDERS INC.
  • Facility Address: 1614 VICTORY BLVD., STE 104
    GLENDALE, CA
    ZIP 91201
  • Facility Phone: 818 392-8080
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: EVELYN G. BASCO
  • NPI Number: 1780194159
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2304323
LAB Type Home Health Agency
Facility Name PROMED HEALTH PROVIDERS INC.
Street 1614 VICTORY BLVD., STE 104
City GLENDALE
State CA
ZIP 91201
Phone 818 392-8080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Home Health Agency
Lab Director EVELYN G. BASCO

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This page was last updated on: 6/4/2025