45D2137437 CLIA NUMBER - C- PORT LLC SERIES B-HOSPICE

Laboratory Demographics

CLIA Number: 45D2137437

Facility Name: C- PORT LLC SERIES B-HOSPICE

Facility Address:
315 S MAIN ST SUITE 100
MANSFIELD, TX
ZIP 76063
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Facility Phone Number: 469 630-2538

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1578090957

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	45D2137437
LAB Type	Hospice
Facility Name	C- PORT LLC SERIES B-HOSPICE
Street	315 S MAIN ST SUITE 100
City	MANSFIELD
State	TX
ZIP	76063
Phone	469 630-2538
CertificateType	4
CertificateEffectiveDate	9/26/2023
CertificateExpirationDate	9/25/2025
FacilityType	Waiver

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