20D1070476 CLIA NUMBER - HOSPICE OF SOUTHERN MAINE

Laboratory Demographics

CLIA Number: 20D1070476

Facility Name: HOSPICE OF SOUTHERN MAINE

Facility Address:
390 US ROUTE 1
SCARBOROUGH, ME
ZIP 04074
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Facility Phone Number: 207 289-3640

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1972594232

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	20D1070476
LAB Type	Hospice
Facility Name	HOSPICE OF SOUTHERN MAINE
Street	390 US ROUTE 1
City	SCARBOROUGH
State	ME
ZIP	04074
Phone	207 289-3640
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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