34D0675740 CLIA NUMBER - COMSERV CREEKSIDE GROUP HOME

Laboratory Demographics

  • CLIA Code: 34D0675740
  • Facility Name: COMSERV CREEKSIDE GROUP HOME
  • Facility Address: 732 HILLSFORM ST NE
    LENOIR, NC
    ZIP 28645
  • Facility Phone: 704 757-0209
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DEBRA T. SMITH
  • NPI Number: 1609909662
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 34D0675740
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name COMSERV CREEKSIDE GROUP HOME
Street 732 HILLSFORM ST NE
City LENOIR
State NC
ZIP 28645
Phone 704 757-0209
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director DEBRA T. SMITH

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