39D1063707 CLIA NUMBER - INDEPENDENT HOME CARE

Laboratory Demographics

  • CLIA Code: 39D1063707
  • Facility Name: INDEPENDENT HOME CARE
  • Facility Address: 9892 BUSTLETON AVENUE SUITE 203
    PHILADELPHIA, PA
    ZIP 19115
  • Facility Phone: 215 821-3078
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: ANNA KRUPOVLYANSKAYA
  • NPI Number: 1619367489
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 39D1063707
LAB Type Home Health Agency
Facility Name INDEPENDENT HOME CARE
Street 9892 BUSTLETON AVENUE SUITE 203
City PHILADELPHIA
State PA
ZIP 19115
Phone 215 821-3078
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Home Health Agency
Lab Director ANNA KRUPOVLYANSKAYA

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