19D2120018 CLIA NUMBER - BRIDGEWAY PSYCHIATRIC CENTER JENNINGS SR CARE HOSPITAL

Laboratory Demographics

  • CLIA Code: 19D2120018
  • Facility Name: BRIDGEWAY PSYCHIATRIC CENTER JENNINGS SR CARE HOSPITAL
  • Facility Address: 3451 5TH AVENUE
    LAKE CHARLES, LA
    ZIP 70607
  • Facility Phone: 337 824-1558
  • Facility Type: Other - PSYCH HOSPITAL HOPD
  • Facility Type: Waiver
  • Lab Director: CLARK WANEKIA
  • NPI Number: 1366433278
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2120018
LAB Type Other - PSYCH HOSPITAL HOPD
Facility Name BRIDGEWAY PSYCHIATRIC CENTER JENNINGS SR CARE HOSPITAL
Street 3451 5TH AVENUE
City LAKE CHARLES
State LA
ZIP 70607
Phone 337 824-1558
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Other - PSYCH HOSPITAL HOPD
Lab Director CLARK WANEKIA

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