28D2077900 CLIA NUMBER - PINE LAKE BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 28D2077900
  • Facility Name: PINE LAKE BEHAVIORAL HEALTH
  • Facility Address: 9100 ANDERMATT DRIVE, SUITE 1
    LINCOLN, NE
    ZIP 68526
  • Facility Phone: (402) 434-2730
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: MR. JARED RAY
  • NPI Number: 1003310061
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 28D2077900
LAB Type Ancillary Testing Site in Health Care Center
Facility Name PINE LAKE BEHAVIORAL HEALTH
Street 9100 ANDERMATT DRIVE, SUITE 1
City LINCOLN
State NE
ZIP 68526
Phone 4024342730
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2026
Certificate Expiration Date 5/15/2028
Facility Type Ancillary Testing Site in Health Care Center
Lab Director MR. JARED RAY

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This page was last updated on: 5/18/2026