45D2300025 CLIA NUMBER - BLUEHAVEN PSYCHIATRY & BROADWAY PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 45D2300025
  • Facility Name: BLUEHAVEN PSYCHIATRY & BROADWAY PSYCHIATRY
  • Facility Address: 3960 BROADWAY BLVD STE 140
    GARLAND, TX
    ZIP 75043
  • Facility Phone: 214 432-1669
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NGOMENI M. MBILIKIRA
  • NPI Number: 1215718184
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 45D2300025
LAB Type Physician Office
Facility Name BLUEHAVEN PSYCHIATRY & BROADWAY PSYCHIATRY
Street 3960 BROADWAY BLVD STE 140
City GARLAND
State TX
ZIP 75043
Phone 214 432-1669
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director NGOMENI M. MBILIKIRA

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