45D2271922 CLIA NUMBER - LEGACY COMMUNITY HEALTH - DASHWOOD

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Laboratory Demographics

CLIA Number: 45D2271922

Facility Name: LEGACY COMMUNITY HEALTH - DASHWOOD

Facility Address:
5420 DASHWOOD DR SUITE 102
HOUSTON, TX
ZIP 77081
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Facility Phone Number: 832 548-5037

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1538414214

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2271922
LAB Type	Federally Qualified Health Center
Facility Name	LEGACY COMMUNITY HEALTH - DASHWOOD
Street	5420 DASHWOOD DR SUITE 102
City	HOUSTON
State	TX
ZIP	77081
Phone	832 548-5037
CertificateType	4
CertificateEffectiveDate	11/10/2022
CertificateExpirationDate	11/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024