19D2270633 CLIA NUMBER - ELEMENTAL HEALTH

Laboratory Demographics

CLIA Number: 19D2270633

Facility Name: ELEMENTAL HEALTH

Facility Address:
778 CHEVELLE DR
BATON ROUGE, LA
ZIP 70806
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Facility Phone Number: 225 218-6774

Facility Type: Other - MENTAL HEALTH OUTPATIENT

Certificate Type: Waiver

NPI Number: 1427775485

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	19D2270633
LAB Type	Other - MENTAL HEALTH OUTPATIENT
Facility Name	ELEMENTAL HEALTH
Street	778 CHEVELLE DR
City	BATON ROUGE
State	LA
ZIP	70806
Phone	225 218-6774
CertificateType	4
CertificateEffectiveDate	10/18/2022
CertificateExpirationDate	10/17/2024
FacilityType	Waiver

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