19D1043372 CLIA NUMBER - CYPRESS GROVE BEHAVIORAL HEALTH TDK, LLC

Laboratory Demographics

CLIA Number: 19D1043372

Facility Name: CYPRESS GROVE BEHAVIORAL HEALTH TDK, LLC

Facility Address:
4673 EUGENE WARE BLVD
BASTROP, LA
ZIP 71220
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Facility Phone Number: 318 281-2448

Facility Type: Hospital

Certificate Type: Waiver

NPI Number: 1598383358

Taxonomy: 283Q00000X - Psychiatric Hospital
An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.

CLIA Record

Field Name	Field Value
CLIA Number	19D1043372
LAB Type	Hospital
Facility Name	CYPRESS GROVE BEHAVIORAL HEALTH TDK, LLC
Street	4673 EUGENE WARE BLVD
City	BASTROP
State	LA
ZIP	71220
Phone	318 281-2448
CertificateType	4
CertificateEffectiveDate	7/22/2023
CertificateExpirationDate	7/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024