05D2324749 CLIA NUMBER - HEAVENLY ADHC

Laboratory Demographics

  • CLIA Code: 05D2324749
  • Facility Name: HEAVENLY ADHC
  • Facility Address: 4777 SANTA MONICA BLVD
    LOS ANGELES, CA
    ZIP 90027
  • Facility Phone: 323 646-6629
  • Facility Type: Other - ADULT DAY HEALTH CARE
  • Facility Type: Waiver
  • Lab Director: LUIS E. VALLE
  • NPI Number: 1679118475
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2324749
LAB Type Other - ADULT DAY HEALTH CARE
Facility Name HEAVENLY ADHC
Street 4777 SANTA MONICA BLVD
City LOS ANGELES
State CA
ZIP 90027
Phone 323 646-6629
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Other - ADULT DAY HEALTH CARE
Lab Director LUIS E. VALLE

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