06D0929857 CLIA NUMBER - PINE RIDGE REHAB AND HEALTHCARE CENTER LLC

Laboratory Demographics

  • CLIA Code: 06D0929857
  • Facility Name: PINE RIDGE REHAB AND HEALTHCARE CENTER LLC
  • Facility Address: 119 BASTILLE DRIVE
    PAGOSA SPRINGS, CO
    ZIP 81157
  • Facility Phone: 970 731-4330
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CODY BUCK
  • NPI Number: 1245237494
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 06D0929857
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PINE RIDGE REHAB AND HEALTHCARE CENTER LLC
Street 119 BASTILLE DRIVE
City PAGOSA SPRINGS
State CO
ZIP 81157
Phone 970 731-4330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CODY BUCK

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