45D2001208 CLIA NUMBER - DELTACARE HOSPICE, LLC DBA ICON HOSPICE

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Laboratory Demographics

CLIA Number: 45D2001208

Facility Name: DELTACARE HOSPICE, LLC DBA ICON HOSPICE

Facility Address:
3132 W MILLER RD SUITE B
GARLAND, TX
ZIP 75041
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Facility Phone Number: 214 473-4790

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1023346343

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	45D2001208
LAB Type	Hospice
Facility Name	DELTACARE HOSPICE, LLC DBA ICON HOSPICE
Street	3132 W MILLER RD SUITE B
City	GARLAND
State	TX
ZIP	75041
Phone	214 473-4790
CertificateType	4
CertificateEffectiveDate	12/15/2023
CertificateExpirationDate	12/14/2025
FacilityType	Waiver

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