25D1103964 CLIA NUMBER - A BRIDGE TO RECOVERY

Laboratory Demographics

  • CLIA Code: 25D1103964
  • Facility Name: A BRIDGE TO RECOVERY
  • Facility Address: 1437 OLD SQUARE RD #101
    JACKSON, MS
    ZIP 39211
  • Facility Phone: 601 977-9353
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KOSTAS MATHEOS
  • NPI Number: 1972631141
  • Taxonomy: 101YM0800X - Counselor

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D1103964
LAB Type Physician Office
Facility Name A BRIDGE TO RECOVERY
Street 1437 OLD SQUARE RD #101
City JACKSON
State MS
ZIP 39211
Phone 601 977-9353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type Physician Office
Lab Director KOSTAS MATHEOS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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