46D1101263 CLIA NUMBER - INTERMOUNTAIN HEALTH HOSPICE - LOGAN

Laboratory Demographics

  • CLIA Code: 46D1101263
  • Facility Name: INTERMOUNTAIN HEALTH HOSPICE - LOGAN
  • Facility Address: 550 EAST 1400 NORTH STE G
    LOGAN, UT
    ZIP 84341
  • Facility Phone: 435 716-5477
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: DOMINIC MOORE
  • NPI Number: 1245305689
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 46D1101263
LAB Type Home Health Agency
Facility Name INTERMOUNTAIN HEALTH HOSPICE - LOGAN
Street 550 EAST 1400 NORTH STE G
City LOGAN
State UT
ZIP 84341
Phone 435 716-5477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2025
Certificate Expiration Date 6/23/2027
Facility Type Home Health Agency
Lab Director DOMINIC MOORE

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