45D0910274 CLIA NUMBER - KEYSTONE HOSPICE CARE, INC DBA CUSTOM CARE HOSPICE

Laboratory Demographics

  • CLIA Code: 45D0910274
  • Facility Name: KEYSTONE HOSPICE CARE, INC DBA CUSTOM CARE HOSPICE
  • Facility Address: 4811 MERLOT AVE SUITE 110
    GRAPEVINE, TX
    ZIP 76051
  • Facility Phone: 972 242-5959
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: MARK SANDERS
  • NPI Number: 1942486402
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 45D0910274
LAB Type Hospice
Facility Name KEYSTONE HOSPICE CARE, INC DBA CUSTOM CARE HOSPICE
Street 4811 MERLOT AVE SUITE 110
City GRAPEVINE
State TX
ZIP 76051
Phone 972 242-5959
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2024
Certificate Expiration Date 1/2/2026
Facility Type Hospice
Lab Director MARK SANDERS

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