10D2305602 CLIA NUMBER - BROWARD PACE PROGRAM LLC

Laboratory Demographics

CLIA Code: 10D2305602
Facility Name: BROWARD PACE PROGRAM LLC
Facility Address: 1700 NW 49TH STREET SUITE 150
FORT LAUDERDALE, FL
ZIP 33309
Facility Phone: 954 768-6232
Facility Type: Community Clinic
Facility Type: Waiver
Lab Director: SHAUN C. CORBETT
NPI Number: 1033924758
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	10D2305602
LAB Type	Community Clinic
Facility Name	BROWARD PACE PROGRAM LLC
Street	1700 NW 49TH STREET SUITE 150
City	FORT LAUDERDALE
State	FL
ZIP	33309
Phone	954 768-6232
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/4/2024
Certificate Expiration Date	6/3/2026
Facility Type	Community Clinic
Lab Director	SHAUN C. CORBETT

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