19D2031259 CLIA NUMBER - PROGRESSIVE PHP OF SEASIDE HEALTH SYSTEM

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Laboratory Demographics

CLIA Number: 19D2031259

Facility Name: PROGRESSIVE PHP OF SEASIDE HEALTH SYSTEM

Facility Address:
12038 GREENWELL SPRINGS/PORT HUDSON ROAD
ZACHARY, LA
ZIP 70791
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Facility Phone Number: 225 654-1560

Facility Type: Other - PARTIAL HOSPITAL PROGRAM

Certificate Type: Waiver

NPI Number: 1609877729

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2031259
LAB Type	Other - PARTIAL HOSPITAL PROGRAM
Facility Name	PROGRESSIVE PHP OF SEASIDE HEALTH SYSTEM
Street	12038 GREENWELL SPRINGS/PORT HUDSON ROAD
City	ZACHARY
State	LA
ZIP	70791
Phone	225 654-1560
CertificateType	4
CertificateEffectiveDate	10/17/2023
CertificateExpirationDate	10/16/2025
FacilityType	Waiver

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