45D0959920 CLIA NUMBER - CHAMPAGNE INC

Laboratory Demographics

CLIA Code: 45D0959920
Facility Name: CHAMPAGNE INC
Facility Address: 217 INDUSTRIAL
LINDALE, TX
ZIP 75771
Facility Phone: 903 882-8337
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: NANCY BRIGHT
NPI Number: 1992873715
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	45D0959920
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CHAMPAGNE INC
Street	217 INDUSTRIAL
City	LINDALE
State	TX
ZIP	75771
Phone	903 882-8337
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/23/2025
Certificate Expiration Date	4/22/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	NANCY BRIGHT

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