20D2207557 CLIA NUMBER - PORT RESOURCES

Laboratory Demographics

CLIA Code: 20D2207557
Facility Name: PORT RESOURCES
Facility Address: 280B GANNETT DRIVE
SOUTH PORTLAND, ME
ZIP 04106
Facility Phone: 207 828-0048
Facility Type: Mobile Laboratory
Facility Type: Waiver
Lab Director: TINA L. DOUCETTE
NPI Number: 1053467779
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	20D2207557
LAB Type	Mobile Laboratory
Facility Name	PORT RESOURCES
Street	280B GANNETT DRIVE
City	SOUTH PORTLAND
State	ME
ZIP	04106
Phone	207 828-0048
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/29/2024
Certificate Expiration Date	12/28/2026
Facility Type	Mobile Laboratory
Lab Director	TINA L. DOUCETTE

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This page was last updated on: 6/4/2025