45D2273604 CLIA NUMBER - SHANE LLC, DBA PINETREE LANE

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Field Name	Field Value
CLIA Number	45D2273604
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SHANE LLC, DBA PINETREE LANE
Street	2002 PINETREE
City	SAN ANTONIO
State	TX
ZIP	78232
Phone	210 403-9372
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/15/2024
Certificate Expiration Date	12/14/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	DARIAN S. WEST

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