45D2181053 CLIA NUMBER - PECAN VALLEY CENTERS

Laboratory Demographics

  • CLIA Code: 45D2181053
  • Facility Name: PECAN VALLEY CENTERS
  • Facility Address: 2101 W PEARL ST
    GRANBURY, TX
    ZIP 76048
  • Facility Phone: 817 579-4400
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: COKE BEATTY
  • NPI Number: 1225309537
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2181053
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name PECAN VALLEY CENTERS
Street 2101 W PEARL ST
City GRANBURY
State TX
ZIP 76048
Phone 817 579-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director COKE BEATTY

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