49D2153228 CLIA NUMBER - CAROLINE COUNTY DETENTION FACILITY

Laboratory Demographics

  • CLIA Code: 49D2153228
  • Facility Name: CAROLINE COUNTY DETENTION FACILITY
  • Facility Address: 11093 SW LEWIS MEMORIAL DRIVE
    BOWLING GREEN, VA
    ZIP 22427
  • Facility Phone: 804 633-0043
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: ESAN O. SIMON
  • NPI Number: 1750393393
  • Taxonomy: 225X00000X - Occupational Therapist

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CLIA Record

Field Name Field Value
CLIA Number 49D2153228
LAB Type Prison
Facility Name CAROLINE COUNTY DETENTION FACILITY
Street 11093 SW LEWIS MEMORIAL DRIVE
City BOWLING GREEN
State VA
ZIP 22427
Phone 804 633-0043
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Prison
Lab Director ESAN O. SIMON

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