45D2169894 CLIA NUMBER - PROVIDENT MEMORY CARE

Laboratory Demographics

  • CLIA Code: 45D2169894
  • Facility Name: PROVIDENT MEMORY CARE
  • Facility Address: 1810 N WASHINGTON
    LIVINGSTON, TX
    ZIP 77351
  • Facility Phone: 936 327-8195
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: GENEVIEVE GONZALES
  • NPI Number: 1992136626
  • Taxonomy: 311500000X - Alzheimer Center (Dementia Center)

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CLIA Record

Field Name Field Value
CLIA Number 45D2169894
LAB Type Assisted Living Facility
Facility Name PROVIDENT MEMORY CARE
Street 1810 N WASHINGTON
City LIVINGSTON
State TX
ZIP 77351
Phone 936 327-8195
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Assisted Living Facility
Lab Director GENEVIEVE GONZALES

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