19D0675254 CLIA NUMBER - PRAIRIE MANOR NURSING HOME

Laboratory Demographics

  • CLIA Code: 19D0675254
  • Facility Name: PRAIRIE MANOR NURSING HOME
  • Facility Address: 1050 EDWIN ELLIOTT DRIVE
    PINE PRAIRIE, LA
    ZIP 70576
  • Facility Phone: 337 599-2031
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TINA O. BROUSSARD
  • NPI Number: 1891778981
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 19D0675254
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRAIRIE MANOR NURSING HOME
Street 1050 EDWIN ELLIOTT DRIVE
City PINE PRAIRIE
State LA
ZIP 70576
Phone 337 599-2031
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 TINA O. BROUSSARD

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