45D2286497 CLIA NUMBER - SOUTHERN LEGACY HOSPICE LLC

Laboratory Demographics

  • CLIA Code: 45D2286497
  • Facility Name: SOUTHERN LEGACY HOSPICE LLC
  • Facility Address: 616 FM 1960 W, SUITE 575
    HOUSTON, TX
    ZIP 77090
  • Facility Phone: 213 550-7205
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SAJID H. SIDDIQUI
  • NPI Number: 1760100697
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 45D2286497
LAB Type Hospice
Facility Name SOUTHERN LEGACY HOSPICE LLC
Street 616 FM 1960 W, SUITE 575
City HOUSTON
State TX
ZIP 77090
Phone 213 550-7205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2025
Certificate Expiration Date 7/30/2027
Facility Type Hospice
Lab Director SAJID H. SIDDIQUI

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