19D2091529 CLIA NUMBER - ACTIVE RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 19D2091529
  • Facility Name: ACTIVE RECOVERY LLC
  • Facility Address: 3821 SOUTHERN AVE
    SHREVEPORT, LA
    ZIP 71106
  • Facility Phone: 318 946-8157
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: TERRI SCHAFFNER
  • NPI Number: 1285998716
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 19D2091529
LAB Type Comp. Outpatient Rehab Facility
Facility Name ACTIVE RECOVERY LLC
Street 3821 SOUTHERN AVE
City SHREVEPORT
State LA
ZIP 71106
Phone 318 946-8157
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director TERRI SCHAFFNER

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This page was last updated on: 6/4/2025