45D1052876 CLIA NUMBER - CUSTOM CARE HOME HEALTH

Laboratory Demographics

  • CLIA Code: 45D1052876
  • Facility Name: CUSTOM CARE HOME HEALTH
  • Facility Address: 4811 MERLOT AVE SUITE 110
    GRAPEVINE, TX
    ZIP 76051
  • Facility Phone: 972 242-5959
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MARK SANDERS
  • NPI Number: 1861620668
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type Home Health Agency
Lab Director MARK SANDERS

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