45D2301380 CLIA NUMBER - ALIVE DIAGNOSTICS

Laboratory Demographics

  • CLIA Code: 45D2301380
  • Facility Name: ALIVE DIAGNOSTICS
  • Facility Address: 2100 N HWY 360 BLDG 4 SUITE 405A
    GRAND PRAIRIE, TX
    ZIP 75050
  • Facility Phone: 817 512-1712
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: ROSELINE J. BOATENG
  • NPI Number: 1699520999
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2301380
LAB Type Independent
Facility Name ALIVE DIAGNOSTICS
Street 2100 N HWY 360 BLDG 4 SUITE 405A
City GRAND PRAIRIE
State TX
ZIP 75050
Phone 817 512-1712
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Independent
Lab Director ROSELINE J. BOATENG

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