45D0954697 CLIA NUMBER - SHORELINE INC

Laboratory Demographics

CLIA Number: 45D0954697

Facility Name: SHORELINE INC

Facility Address:
1220 GREGORY STREET
TAFT, TX
ZIP 78390
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Facility Phone Number: 361 643-6643

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1962559252

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0954697
LAB Type	Other
Facility Name	SHORELINE INC
Street	1220 GREGORY STREET
City	TAFT
State	TX
ZIP	78390
Phone	361 643-6643
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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