45D2030960 CLIA NUMBER - ELYSIAN HOSPICE, LLC DBA ELYSIAN HOSPICE

Laboratory Demographics

  • CLIA Code: 45D2030960
  • Facility Name: ELYSIAN HOSPICE, LLC DBA ELYSIAN HOSPICE
  • Facility Address: 16750 WESTGROVE DRIVE SUITE 100
    ADDISON, TX
    ZIP 75001
  • Facility Phone: 972 224-1876
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: TINA FORTNER
  • NPI Number: 1568633220
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 45D2030960
LAB Type Hospice
Facility Name ELYSIAN HOSPICE, LLC DBA ELYSIAN HOSPICE
Street 16750 WESTGROVE DRIVE SUITE 100
City ADDISON
State TX
ZIP 75001
Phone 972 224-1876
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2025
Certificate Expiration Date 10/9/2027
Facility Type Hospice
Lab Director TINA FORTNER

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