42D2005418 CLIA NUMBER - CHARLES LEA CENTER

Laboratory Demographics

  • CLIA Code: 42D2005418
  • Facility Name: CHARLES LEA CENTER
  • Facility Address: 195 BURDETTE STREET ATTN FAITH BURKE
    SPARTANBURG, SC
    ZIP 29307
  • Facility Phone: 864 562-2422
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: SUSAN SMITH
  • NPI Number: 1689120503
  • Taxonomy: 1041C0700X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 42D2005418
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name CHARLES LEA CENTER
Street 195 BURDETTE STREET ATTN FAITH BURKE
City SPARTANBURG
State SC
ZIP 29307
Phone 864 562-2422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2024
Certificate Expiration Date 3/25/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director SUSAN SMITH

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