19D2261950 CLIA NUMBER - ESSENTIAL WELLCARE, LLC

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Laboratory Demographics

CLIA Number: 19D2261950

Facility Name: ESSENTIAL WELLCARE, LLC

Facility Address:
3419 NW EVANGELINE THRUWAY, SUITE A8
CARENCRO, LA
ZIP 70520
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Facility Phone Number: 337 852-5742

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1841932563

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	19D2261950
LAB Type	Mobile Laboratory
Facility Name	ESSENTIAL WELLCARE, LLC
Street	3419 NW EVANGELINE THRUWAY, SUITE A8
City	CARENCRO
State	LA
ZIP	70520
Phone	337 852-5742
CertificateType	4
CertificateEffectiveDate	6/7/2022
CertificateExpirationDate	6/6/2024
FacilityType	Waiver

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