10D2237441 CLIA NUMBER - SHINING STARS PEDIATRIC EXTENDED CARE

Laboratory Demographics

CLIA Number: 10D2237441

Facility Name: SHINING STARS PEDIATRIC EXTENDED CARE

Facility Address:
5201 RAVENSWOOD ROAD, SUITE 110
FORT LAUDERDALE, FL
ZIP 33312
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Facility Phone Number: 786 496-0287

Facility Type: Other - PRESCRIBED EXTENDED CARE

Certificate Type: Waiver

NPI Number: 1326647363

Taxonomy: 261QM3000X - Clinic/Center
An entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.).

CLIA Record

Field Name	Field Value
CLIA Number	10D2237441
LAB Type	Other - PRESCRIBED EXTENDED CARE
Facility Name	SHINING STARS PEDIATRIC EXTENDED CARE
Street	5201 RAVENSWOOD ROAD, SUITE 110
City	FORT LAUDERDALE
State	FL
ZIP	33312
Phone	786 496-0287
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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