45D2064408 CLIA NUMBER - CARRIAGE INN-LAKE JACKSON

Laboratory Demographics

  • CLIA Code: 45D2064408
  • Facility Name: CARRIAGE INN-LAKE JACKSON
  • Facility Address: 130 LAKE ROAD
    LAKE JACKSON, TX
    ZIP 77566
  • Facility Phone: 979 285-0300
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DAKOTA LAKE
  • NPI Number: 1285985929
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D2064408
LAB Type Assisted Living Facility
Facility Name CARRIAGE INN-LAKE JACKSON
Street 130 LAKE ROAD
City LAKE JACKSON
State TX
ZIP 77566
Phone 979 285-0300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2024
Certificate Expiration Date 7/21/2026
Facility Type Assisted Living Facility
Lab Director DAKOTA LAKE

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