17D2187160 CLIA NUMBER - MY HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 17D2187160
  • Facility Name: MY HOME CARE LLC
  • Facility Address: 1037 S BROADWAY AVE
    WICHITA, KS
    ZIP 67211
  • Facility Phone: 316 204-7335
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: SOMPHIEN AMPHONE
  • NPI Number: 1780209882
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 17D2187160
LAB Type Home Health Agency
Facility Name MY HOME CARE LLC
Street 1037 S BROADWAY AVE
City WICHITA
State KS
ZIP 67211
Phone 316 204-7335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/26/2024
Certificate Expiration Date 6/25/2026
Facility Type Home Health Agency
Lab Director SOMPHIEN AMPHONE

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