45D2138404 CLIA NUMBER - LEGACY COMMUNITY HEALTH KIPP-DREAM

Laboratory Demographics

  • CLIA Code: 45D2138404
  • Facility Name: LEGACY COMMUNITY HEALTH KIPP-DREAM
  • Facility Address: 500 TIDWELL
    HOUSTON, TX
    ZIP 77022
  • Facility Phone: 713 814-3293
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: SUSANNA BLANCHARD
  • NPI Number: 1245583590
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2138404
LAB Type Federally Qualified Health Center
Facility Name LEGACY COMMUNITY HEALTH KIPP-DREAM
Street 500 TIDWELL
City HOUSTON
State TX
ZIP 77022
Phone 713 814-3293
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2023
Certificate Expiration Date 10/16/2025
Facility Type Federally Qualified Health Center
Lab Director SUSANNA BLANCHARD

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This page was last updated on: 6/4/2025