45D0968448 CLIA NUMBER - MAGNOLIA MANOR

Laboratory Demographics

  • CLIA Code: 45D0968448
  • Facility Name: MAGNOLIA MANOR
  • Facility Address: 4400 GULF STREET
    GROVES, TX
    ZIP 77619
  • Facility Phone: 409 962-5785
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DELPHIA SMITH
  • NPI Number: 1659769420
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D0968448
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MAGNOLIA MANOR
Street 4400 GULF STREET
City GROVES
State TX
ZIP 77619
Phone 409 962-5785
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DELPHIA SMITH

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