45D2204905 CLIA NUMBER - BANYAN TEXAS LLC

Laboratory Demographics

  • CLIA Code: 45D2204905
  • Facility Name: BANYAN TEXAS LLC
  • Facility Address: 4168 COUNTY ROAD 444
    WAELDER, TX
    ZIP 78959
  • Facility Phone: 830 283-3003
  • Facility Type: Other - SUBSTANCE ABUSE TREATMENT
  • Facility Type: Waiver
  • Lab Director: SANDRA L. VAN WYCK
  • NPI Number: 1629689559
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Other - SUBSTANCE ABUSE TREATMENT
Lab Director SANDRA L. VAN WYCK

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