19D0673760 CLIA NUMBER - SPRING LAKE SKILLED NURSING AND REHABILITATION

Laboratory Demographics

  • CLIA Code: 19D0673760
  • Facility Name: SPRING LAKE SKILLED NURSING AND REHABILITATION
  • Facility Address: 8622 LINE AVENUE
    SHREVEPORT, LA
    ZIP 71106
  • Facility Phone: 318 868-4126
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: STEPHEN PETERSON
  • NPI Number: 1861873614
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 19D0673760
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SPRING LAKE SKILLED NURSING AND REHABILITATION
Street 8622 LINE AVENUE
City SHREVEPORT
State LA
ZIP 71106
Phone 318 868-4126
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 STEPHEN PETERSON

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