22D2253826 CLIA NUMBER - SOUTHBOROUGH BOARD OF HEALTH

Laboratory Demographics

CLIA Number: 22D2253826

Facility Name: SOUTHBOROUGH BOARD OF HEALTH

Facility Address:
9 CORDAVILLE RD BASEMENT LEVEL
SOUTHBOROUGH, MA
ZIP 01772
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Facility Phone Number: 508 481-3013

Facility Type: Other - BOARD OF HEALTH

Certificate Type: Waiver

NPI Number: 1376676130

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	22D2253826
LAB Type	Other - BOARD OF HEALTH
Facility Name	SOUTHBOROUGH BOARD OF HEALTH
Street	9 CORDAVILLE RD BASEMENT LEVEL
City	SOUTHBOROUGH
State	MA
ZIP	01772
Phone	508 481-3013
CertificateType	4
CertificateEffectiveDate	2/24/2024
CertificateExpirationDate	2/23/2026
FacilityType	Waiver

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