45D1052876 CLIA NUMBER - CUSTOM CARE HOME HEALTH

Laboratory Demographics

CLIA Number: 45D1052876

Facility Name: CUSTOM CARE HOME HEALTH

Facility Address:
4811 MERLOT AVE SUITE 110
GRAPEVINE, TX
ZIP 76051
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Facility Phone Number: 972 242-5959

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1861620668

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	45D1052876
LAB Type	Home Health Agency
Facility Name	CUSTOM CARE HOME HEALTH
Street	4811 MERLOT AVE SUITE 110
City	GRAPEVINE
State	TX
ZIP	76051
Phone	972 242-5959
CertificateType	4
CertificateEffectiveDate	4/6/2024
CertificateExpirationDate	4/5/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024