19D0672744 CLIA NUMBER - SHREVEPORT MANOR SKILLED NURSING & REHABILITATION

Laboratory Demographics

  • CLIA Code: 19D0672744
  • Facility Name: SHREVEPORT MANOR SKILLED NURSING & REHABILITATION
  • Facility Address: 3302 MANSFIELD RD
    SHREVEPORT, LA
    ZIP 71103
  • Facility Phone: 318 222-9482
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOHN T. MAULDIN
  • NPI Number: 1609257450
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 19D0672744
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SHREVEPORT MANOR SKILLED NURSING & REHABILITATION
Street 3302 MANSFIELD RD
City SHREVEPORT
State LA
ZIP 71103
Phone 318 222-9482
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JOHN T. MAULDIN

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