45D2218579 CLIA NUMBER - BLUE HERON RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 45D2218579
  • Facility Name: BLUE HERON RECOVERY LLC
  • Facility Address: 2015 NE LOOP 410
    SAN ANTONIO, TX
    ZIP 78217
  • Facility Phone: 210 588-0508
  • Facility Type: Other - OUTPT SUBSTANCE ABUSE TX
  • Facility Type: Waiver
  • Lab Director: PAUL MAYER
  • NPI Number: 1861098188
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2218579
LAB Type Other - OUTPT SUBSTANCE ABUSE TX
Facility Name BLUE HERON RECOVERY LLC
Street 2015 NE LOOP 410
City SAN ANTONIO
State TX
ZIP 78217
Phone 210 588-0508
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Other - OUTPT SUBSTANCE ABUSE TX
Lab Director PAUL MAYER

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