53D0903721 CLIA NUMBER - ST JOHN'S HOME CARE

Laboratory Demographics

  • CLIA Code: 53D0903721
  • Facility Name: ST JOHN'S HOME CARE
  • Facility Address: 555 E BROADWAY STE 115
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 307 739-7465
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MS. LAURA LEE BERRETT
  • NPI Number: 1194744235
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 53D0903721
LAB Type Home Health Agency
Facility Name ST JOHN'S HOME CARE
Street 555 E BROADWAY STE 115
City JACKSON
State WY
ZIP 83001
Phone 307 739-7465
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Home Health Agency
Lab Director MS. LAURA LEE BERRETT

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