22D0992987 CLIA NUMBER - SOUTHBOROUGH SENIOR CENTER

Laboratory Demographics

CLIA Number: 22D0992987

Facility Name: SOUTHBOROUGH SENIOR CENTER

Facility Address:
9 CORDAVILLE ROAD
SOUTHBOROUGH, MA
ZIP 01772
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Facility Phone Number: 508 229-4453

Facility Type: Health Fair

Certificate Type: Waiver

NPI Number: 1053585869

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	22D0992987
LAB Type	Health Fair
Facility Name	SOUTHBOROUGH SENIOR CENTER
Street	9 CORDAVILLE ROAD
City	SOUTHBOROUGH
State	MA
ZIP	01772
Phone	508 229-4453
CertificateType	4
CertificateEffectiveDate	11/1/2023
CertificateExpirationDate	10/31/2025
FacilityType	Waiver

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