05D2308558 CLIA NUMBER - SUPREME HOME CARE SERVICES, INC

Laboratory Demographics

  • CLIA Code: 05D2308558
  • Facility Name: SUPREME HOME CARE SERVICES, INC
  • Facility Address: 100 N BRAND BLVD STE 416
    GLENDALE, CA
    ZIP 91203
  • Facility Phone: 818 434-6172
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: BERJ DERMENDJIAN
  • NPI Number: 1871193169
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2308558
LAB Type Home Health Agency
Facility Name SUPREME HOME CARE SERVICES, INC
Street 100 N BRAND BLVD STE 416
City GLENDALE
State CA
ZIP 91203
Phone 818 434-6172
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Home Health Agency
Lab Director BERJ DERMENDJIAN

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