45D2283844 CLIA NUMBER - BLACK HEART ASSOCIATION

Laboratory Demographics

  • CLIA Code: 45D2283844
  • Facility Name: BLACK HEART ASSOCIATION
  • Facility Address: 1029 KAYLIE ST
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 646-0031
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: TARA P. ROBINSON
  • NPI Number: 1720756844
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2283844
LAB Type Mobile Laboratory
Facility Name BLACK HEART ASSOCIATION
Street 1029 KAYLIE ST
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 646-0031
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Mobile Laboratory
Lab Director TARA P. ROBINSON

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