45D2026515 CLIA NUMBER - PROVIDENCE WELLNESS CENTER, LLC

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Laboratory Demographics

CLIA Number: 45D2026515

Facility Name: PROVIDENCE WELLNESS CENTER, LLC

Facility Address:
13155 WESTHEIMER ROAD SUITE #133
HOUSTON, TX
ZIP 77077
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Facility Phone Number: 281 920-0344

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1790061315

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	45D2026515
LAB Type	Practitioner Other
Facility Name	PROVIDENCE WELLNESS CENTER, LLC
Street	13155 WESTHEIMER ROAD SUITE #133
City	HOUSTON
State	TX
ZIP	77077
Phone	281 920-0344
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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