19D2259783 CLIA NUMBER - REGIONAL HOSPICE CARE GROUP OF NW LOUISIANA, LLC

Laboratory Demographics

CLIA Number: 19D2259783

Facility Name: REGIONAL HOSPICE CARE GROUP OF NW LOUISIANA, LLC

Facility Address:
9301 WALLACE LAKE RD
SHREVEPORT, LA
ZIP 71106
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Facility Phone Number: 318 524-1046

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1265437743

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2259783
LAB Type	Hospice
Facility Name	REGIONAL HOSPICE CARE GROUP OF NW LOUISIANA, LLC
Street	9301 WALLACE LAKE RD
City	SHREVEPORT
State	LA
ZIP	71106
Phone	318 524-1046
CertificateType	4
CertificateEffectiveDate	5/11/2024
CertificateExpirationDate	5/10/2026
FacilityType	Waiver

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