45D0993579 CLIA NUMBER - SAN ANGELO STATE SCHOOL SUPPORTED LIVING CENTER

Laboratory Demographics

  • CLIA Code: 45D0993579
  • Facility Name: SAN ANGELO STATE SCHOOL SUPPORTED LIVING CENTER
  • Facility Address: 11640 US HIGHWAY 87 NORTH
    CARLSBAD, TX
    ZIP 76934
  • Facility Phone: 325 465-4391
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DR. DAVID JOLIVET
  • NPI Number: 1346333945
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 45D0993579
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name SAN ANGELO STATE SCHOOL SUPPORTED LIVING CENTER
Street 11640 US HIGHWAY 87 NORTH
City CARLSBAD
State TX
ZIP 76934
Phone 325 465-4391
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. DAVID JOLIVET

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