01D2156953 CLIA NUMBER - EVERNORTH DIRECT HEALTH LLC BRIDGEPORT HEALTHY LIFE CENTER

Laboratory Demographics

  • CLIA Code: 01D2156953
  • Facility Name: EVERNORTH DIRECT HEALTH LLC BRIDGEPORT HEALTHY LIFE CENTER
  • Facility Address: 202 JACOBS AVENUE
    BRIDGEPORT, AL
    ZIP 35740
  • Facility Phone: 480 868-0646
  • Facility Type: Other - OUT PATIENT
  • Facility Type: Waiver
  • Lab Director: MRS. MISTY CHESSOR
  • NPI Number: 1245920131
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D2156953
LAB Type Other - OUT PATIENT
Facility Name EVERNORTH DIRECT HEALTH LLC BRIDGEPORT HEALTHY LIFE CENTER
Street 202 JACOBS AVENUE
City BRIDGEPORT
State AL
ZIP 35740
Phone 480 868-0646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Other - OUT PATIENT
Lab Director MRS. MISTY CHESSOR

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