45D2061072 CLIA NUMBER - FULSHEAR TREATMENT TO TRANSITION

Laboratory Demographics

  • CLIA Code: 45D2061072
  • Facility Name: FULSHEAR TREATMENT TO TRANSITION
  • Facility Address: 4800 SUGAR GROVE BLVD STE 275
    STAFFORD, TX
    ZIP 77477
  • Facility Phone: 979 793-3034
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ERICA SITKA
  • NPI Number: 1558148874
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2061072
LAB Type Assisted Living Facility
Facility Name FULSHEAR TREATMENT TO TRANSITION
Street 4800 SUGAR GROVE BLVD STE 275
City STAFFORD
State TX
ZIP 77477
Phone 979 793-3034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2023
Certificate Expiration Date 6/20/2025
Facility Type Assisted Living Facility
Lab Director ERICA SITKA

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This page was last updated on: 3/20/2025