45D0889511 CLIA NUMBER - LUBBOCK STATE SUPPORTED LIVING CENTER

Laboratory Demographics

CLIA Number: 45D0889511

Facility Name: LUBBOCK STATE SUPPORTED LIVING CENTER

Facility Address:
3401 NORTH UNIVERSITY
LUBBOCK, TX
ZIP 79417
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Facility Phone Number: 806 763-7041

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1649363326

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	45D0889511
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LUBBOCK STATE SUPPORTED LIVING CENTER
Street	3401 NORTH UNIVERSITY
City	LUBBOCK
State	TX
ZIP	79417
Phone	806 763-7041
CertificateType	4
CertificateEffectiveDate	4/25/2023
CertificateExpirationDate	4/24/2025
FacilityType	Waiver

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