44D2043141 CLIA NUMBER - VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER

Laboratory Demographics

  • CLIA Code: 44D2043141
  • Facility Name: VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER
  • Facility Address: 58 CARRIAGE HOUSE DR STE B
    JACKSON, TN
    ZIP 38305
  • Facility Phone: 731 660-0880
  • Facility Type: Other - OUTPATIENT TREATMENT
  • Facility Type: Waiver
  • Lab Director: SHERYL BANAAG
  • NPI Number: 1639515646
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D2043141
LAB Type Other - OUTPATIENT TREATMENT
Facility Name VCPHCS XIX, LLC DBA BHG JACKSON TREATMENT CENTER
Street 58 CARRIAGE HOUSE DR STE B
City JACKSON
State TN
ZIP 38305
Phone 731 660-0880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Other - OUTPATIENT TREATMENT
Lab Director SHERYL BANAAG

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