15D2165063 CLIA NUMBER - VISTA HOSPICE CARE, LLC D/B/A GENTIVA III

Laboratory Demographics

CLIA Number: 15D2165063

Facility Name: VISTA HOSPICE CARE, LLC D/B/A GENTIVA III

Facility Address:
6845 EAST US HIGHWAY 36, STE 410
AVON, IN
ZIP 46123
Get Directions

Facility Phone Number: 704 664-2876

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1447505144

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	15D2165063
LAB Type	Hospice
Facility Name	VISTA HOSPICE CARE, LLC D/B/A GENTIVA III
Street	6845 EAST US HIGHWAY 36, STE 410
City	AVON
State	IN
ZIP	46123
Phone	704 664-2876
CertificateType	4
CertificateEffectiveDate	4/18/2023
CertificateExpirationDate	4/17/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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