45D1031223 CLIA NUMBER - PROVIDIAN HEALTH CARE INC

Laboratory Demographics

  • CLIA Code: 45D1031223
  • Facility Name: PROVIDIAN HEALTH CARE INC
  • Facility Address: 2421 ROY ROAD, SUITE 101
    PEARLAND, TX
    ZIP 77581
  • Facility Phone: 281 997-6272
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MERRILL MOHAN
  • NPI Number: 1063460483
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 45D1031223
LAB Type Home Health Agency
Facility Name PROVIDIAN HEALTH CARE INC
Street 2421 ROY ROAD, SUITE 101
City PEARLAND
State TX
ZIP 77581
Phone 281 997-6272
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Home Health Agency
Lab Director MERRILL MOHAN

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This page was last updated on: 6/4/2025