45D0688124 CLIA NUMBER - SPJST REST HOME 1

Laboratory Demographics

  • CLIA Code: 45D0688124
  • Facility Name: SPJST REST HOME 1
  • Facility Address: 1810 OLD GRANGER ROAD
    TAYLOR, TX
    ZIP 76574
  • Facility Phone: 512 352-6337
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DANA JOHNSON
  • NPI Number: 1871633305
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D0688124
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SPJST REST HOME 1
Street 1810 OLD GRANGER ROAD
City TAYLOR
State TX
ZIP 76574
Phone 512 352-6337
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 Skilled Nursing Facility/Nursing Facility
Lab Director DANA JOHNSON

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