19D2100823 CLIA NUMBER - KIDCARE LOUISIANA

Laboratory Demographics

CLIA Number: 19D2100823

Facility Name: KIDCARE LOUISIANA

Facility Address:
2801 FOURTH STREET, SUITE 2
JONESVILLE, LA
ZIP 71343
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Facility Phone Number: 318 339-9901

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1073903910

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2100823
LAB Type	Rural Health Clinic
Facility Name	KIDCARE LOUISIANA
Street	2801 FOURTH STREET, SUITE 2
City	JONESVILLE
State	LA
ZIP	71343
Phone	318 339-9901
CertificateType	4
CertificateEffectiveDate	8/24/2023
CertificateExpirationDate	8/23/2025
FacilityType	Waiver

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