45D1050058 CLIA NUMBER - PREMIER GOLDEN HEART HEALTHCARE SERVICES

Laboratory Demographics

  • CLIA Code: 45D1050058
  • Facility Name: PREMIER GOLDEN HEART HEALTHCARE SERVICES
  • Facility Address: 2412 OLD NORTH RD STE 101 K
    DENTON, TX
    ZIP 76209
  • Facility Phone: 940 566-4999
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: NDIFREKE U. ITATA
  • NPI Number: 1033279252
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 45D1050058
LAB Type Home Health Agency
Facility Name PREMIER GOLDEN HEART HEALTHCARE SERVICES
Street 2412 OLD NORTH RD STE 101 K
City DENTON
State TX
ZIP 76209
Phone 940 566-4999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2024
Certificate Expiration Date 1/23/2026
Facility Type Home Health Agency
Lab Director NDIFREKE U. ITATA

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This page was last updated on: 3/20/2025