45D2143848 CLIA NUMBER - LEENA CHACKO MD PA DBA FAMILY AND AGING CENTER

Laboratory Demographics

  • CLIA Code: 45D2143848
  • Facility Name: LEENA CHACKO MD PA DBA FAMILY AND AGING CENTER
  • Facility Address: 129 VISION PARK SUITE 105
    SHENANDOAH, TX
    ZIP 77384
  • Facility Phone: 832 295-9829
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEENA CHACKO
  • NPI Number: 1346208279
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2143848
LAB Type Physician Office
Facility Name LEENA CHACKO MD PA DBA FAMILY AND AGING CENTER
Street 129 VISION PARK SUITE 105
City SHENANDOAH
State TX
ZIP 77384
Phone 832 295-9829
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Physician Office
Lab Director LEENA CHACKO

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