45D2237309 CLIA NUMBER - NEXPHASE HEALTHCARE, LLC

Laboratory Demographics

CLIA Number: 45D2237309

Facility Name: NEXPHASE HEALTHCARE, LLC

Facility Address:
2401 CALLENDER RD SUITE 109
MANSFIELD, TX
ZIP 76063
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Facility Phone Number: 817 617-2035

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1497369474

Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	45D2237309
LAB Type	Practitioner Other
Facility Name	NEXPHASE HEALTHCARE, LLC
Street	2401 CALLENDER RD SUITE 109
City	MANSFIELD
State	TX
ZIP	76063
Phone	817 617-2035
CertificateType	4
CertificateEffectiveDate	9/23/2023
CertificateExpirationDate	9/22/2025
FacilityType	Waiver

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