11D1076785 CLIA NUMBER - ALTUS HOSPICE OF GEORGIA, LLC DBA HEART OF HOSPICE WEST ATLANTA

Laboratory Demographics

CLIA Number: 11D1076785

Facility Name: ALTUS HOSPICE OF GEORGIA, LLC DBA HEART OF HOSPICE WEST ATLANTA

Facility Address:
1 COMMUNITY SQUARE BOULEVARD SUITE 302
VILLA RICA, GA
ZIP 30180
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Facility Phone Number: 770 456-4643

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1609115567

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	11D1076785
LAB Type	Hospice
Facility Name	ALTUS HOSPICE OF GEORGIA, LLC DBA HEART OF HOSPICE WEST ATLANTA
Street	1 COMMUNITY SQUARE BOULEVARD SUITE 302
City	VILLA RICA
State	GA
ZIP	30180
Phone	770 456-4643
CertificateType	4
CertificateEffectiveDate	11/26/2023
CertificateExpirationDate	11/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024