19D2194813 CLIA NUMBER - MID CITY COMMUNITY NURSING AND REHAB 4005 BR SNF, LLC

Laboratory Demographics

  • CLIA Code: 19D2194813
  • Facility Name: MID CITY COMMUNITY NURSING AND REHAB 4005 BR SNF, LLC
  • Facility Address: 4005 NORTH BLVD
    BATON ROUGE, LA
    ZIP 70806
  • Facility Phone: 225 387-5934
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHANTA HAYNES
  • NPI Number: 1962879908
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2194813
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MID CITY COMMUNITY NURSING AND REHAB 4005 BR SNF, LLC
Street 4005 NORTH BLVD
City BATON ROUGE
State LA
ZIP 70806
Phone 225 387-5934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHANTA HAYNES

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This page was last updated on: 9/29/2025