45D1018067 CLIA NUMBER - DIVINE HOSPICE DBA PROFFESSIONAL HOSPICE

Laboratory Demographics

  • CLIA Code: 45D1018067
  • Facility Name: DIVINE HOSPICE DBA PROFFESSIONAL HOSPICE
  • Facility Address: 345 WESTPARK WAY STE, 101
    EULESS, TX
    ZIP 76040
  • Facility Phone: 817 268-1946
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: CONSOLATA A. BRYANT
  • NPI Number: 1285679118
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 45D1018067
LAB Type Hospice
Facility Name DIVINE HOSPICE DBA PROFFESSIONAL HOSPICE
Street 345 WESTPARK WAY STE, 101
City EULESS
State TX
ZIP 76040
Phone 817 268-1946
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2025
Certificate Expiration Date 10/13/2027
Facility Type Hospice
Lab Director CONSOLATA A. BRYANT

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