45D2204905 CLIA NUMBER - BANYAN TEXAS LLC

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Laboratory Demographics

CLIA Number: 45D2204905

Facility Name: BANYAN TEXAS LLC

Facility Address:
4168 COUNTY ROAD 444
WAELDER, TX
ZIP 78959
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Facility Phone Number: 830 283-3003

Facility Type: Other - SUBSTANCE ABUSE TREATMENT

Certificate Type: Waiver

NPI Number: 1629689559

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	45D2204905
LAB Type	Other - SUBSTANCE ABUSE TREATMENT
Facility Name	BANYAN TEXAS LLC
Street	4168 COUNTY ROAD 444
City	WAELDER
State	TX
ZIP	78959
Phone	830 283-3003
CertificateType	4
CertificateEffectiveDate	12/11/2022
CertificateExpirationDate	12/10/2024
FacilityType	Waiver

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