34D2307243 CLIA NUMBER - LIFESPAN, INC

Laboratory Demographics

  • CLIA Code: 34D2307243
  • Facility Name: LIFESPAN, INC
  • Facility Address: 1511 SHOPTON RD SUITE A
    CHARLOTTE, NC
    ZIP 28217
  • Facility Phone: 704 944-5100
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ROBIN DEVORE
  • NPI Number: 1376927236
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 34D2307243
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name LIFESPAN, INC
Street 1511 SHOPTON RD SUITE A
City CHARLOTTE
State NC
ZIP 28217
Phone 704 944-5100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/3/2024
Certificate Expiration Date 7/2/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ROBIN DEVORE

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This page was last updated on: 9/29/2025