45D2095407 CLIA NUMBER - RENATUS CARE, LLC DBA PROVISTA HOSPICE

Laboratory Demographics

  • CLIA Code: 45D2095407
  • Facility Name: RENATUS CARE, LLC DBA PROVISTA HOSPICE
  • Facility Address: 4849 GREENVILLE AVE SUITE 1125
    DALLAS, TX
    ZIP 75206
  • Facility Phone: 214 299-8566
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: TRACY GALVAN
  • NPI Number: 1043607039
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 45D2095407
LAB Type Hospice
Facility Name RENATUS CARE, LLC DBA PROVISTA HOSPICE
Street 4849 GREENVILLE AVE SUITE 1125
City DALLAS
State TX
ZIP 75206
Phone 214 299-8566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2024
Certificate Expiration Date 8/13/2026
Facility Type Hospice
Lab Director TRACY GALVAN

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