45D2217910 CLIA NUMBER - MIRABELLA ASSITED LIVING

Laboratory Demographics

  • CLIA Code: 45D2217910
  • Facility Name: MIRABELLA ASSITED LIVING
  • Facility Address: 4242 BRYANT IRVIN RD
    FORT WORTH, TX
    ZIP 76109
  • Facility Phone: 817 763-0088
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JEFF TREML
  • NPI Number: 1528283280
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D2217910
LAB Type Assisted Living Facility
Facility Name MIRABELLA ASSITED LIVING
Street 4242 BRYANT IRVIN RD
City FORT WORTH
State TX
ZIP 76109
Phone 817 763-0088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Assisted Living Facility
Lab Director JEFF TREML

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