05D2307926 CLIA NUMBER - PROVITAL CARE INC

Laboratory Demographics

  • CLIA Code: 05D2307926
  • Facility Name: PROVITAL CARE INC
  • Facility Address: 20953 DEVONSHIRE ST STE 6
    CHATSWORTH, CA
    ZIP 91311
  • Facility Phone: 747 282-1555
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: VICTORY M. BOROVSKY
  • NPI Number: 1346874062
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2307926
LAB Type Home Health Agency
Facility Name PROVITAL CARE INC
Street 20953 DEVONSHIRE ST STE 6
City CHATSWORTH
State CA
ZIP 91311
Phone 747 282-1555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type Home Health Agency
Lab Director VICTORY M. BOROVSKY

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