45D2028912 CLIA NUMBER - BLUE BONNET PALIATIVE CARE

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Laboratory Demographics

CLIA Number: 45D2028912

Facility Name: BLUE BONNET PALIATIVE CARE

Facility Address:
12111 RR12 STE # 114
WIMBERLEY, TX
ZIP 78676
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Facility Phone Number: 512 537-8950

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1770873895

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	45D2028912
LAB Type	Hospice
Facility Name	BLUE BONNET PALIATIVE CARE
Street	12111 RR12 STE # 114
City	WIMBERLEY
State	TX
ZIP	78676
Phone	512 537-8950
CertificateType	4
CertificateEffectiveDate	8/26/2023
CertificateExpirationDate	8/25/2025
FacilityType	Waiver

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