19D0710963 CLIA NUMBER - PINECREST SUPPORTS & SERVICES CENTER

Laboratory Demographics

CLIA Code: 19D0710963
Facility Name: PINECREST SUPPORTS & SERVICES CENTER
Facility Address: 100 PINECREST DRIVE
PINEVILLE, LA
ZIP 71361
Facility Phone: 318 641-2042
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: NANCY A. BROWN
NPI Number: 1609053727
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	19D0710963
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PINECREST SUPPORTS & SERVICES CENTER
Street	100 PINECREST DRIVE
City	PINEVILLE
State	LA
ZIP	71361
Phone	318 641-2042
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/31/2025
Certificate Expiration Date	3/30/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	NANCY A. BROWN

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