Healthcare Provider Details

I. General information

NPI: 1871347252
Provider Name (Legal Business Name): HERO CLINICAL LABATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 BIRCH BND
MESQUITE TX
75181-1837
US

IV. Provider business mailing address

2125 BIRCH BND
MESQUITE TX
75181-1837
US

V. Phone/Fax

Practice location:
  • Phone: 214-283-4573
  • Fax:
Mailing address:
  • Phone: 214-283-4573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: NICOLE PENNEGRAPH
Title or Position: ADMINISTRATOR
Credential: MEDICAL ASSISTANT
Phone: 945-536-1396