45D0889511 CLIA NUMBER - LUBBOCK STATE SUPPORTED LIVING CENTER

Laboratory Demographics

  • CLIA Code: 45D0889511
  • Facility Name: LUBBOCK STATE SUPPORTED LIVING CENTER
  • Facility Address: 3401 NORTH UNIVERSITY
    LUBBOCK, TX
    ZIP 79417
  • Facility Phone: 806 763-7041
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DR. CAROLYN MCDOUGALD
  • NPI Number: 1649363326
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director DR. CAROLYN MCDOUGALD

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