19D2208892 CLIA NUMBER - MAGNOLIA RECOVERY

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Laboratory Demographics

CLIA Number: 19D2208892

Facility Name: MAGNOLIA RECOVERY

Facility Address:
3605 YOUREE DRIVE
SHREVE ISLAND, LA
ZIP 71105
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Facility Phone Number: 318 615-9000

Facility Type: Other - SUBSTANCE ABUSE

Certificate Type: Waiver

NPI Number: 1124482617

Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

CLIA Record

Field Name	Field Value
CLIA Number	19D2208892
LAB Type	Other - SUBSTANCE ABUSE
Facility Name	MAGNOLIA RECOVERY
Street	3605 YOUREE DRIVE
City	SHREVE ISLAND
State	LA
ZIP	71105
Phone	318 615-9000
CertificateType	4
CertificateEffectiveDate	1/8/2023
CertificateExpirationDate	1/7/2025
FacilityType	Waiver

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