45D2115432 CLIA NUMBER - VISTA RUN

Laboratory Demographics

CLIA Number: 45D2115432

Facility Name: VISTA RUN

Facility Address:
5303 VISTA RUN
SAN ANTONIO, TX
ZIP 78247
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Facility Phone Number: 210 979-7009

Facility Type: Other - GROUP HOME

Certificate Type: Waiver

NPI Number: 1528268018

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	45D2115432
LAB Type	Other - GROUP HOME
Facility Name	VISTA RUN
Street	5303 VISTA RUN
City	SAN ANTONIO
State	TX
ZIP	78247
Phone	210 979-7009
CertificateType	4
CertificateEffectiveDate	7/7/2022
CertificateExpirationDate	7/6/2024
FacilityType	Waiver

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