01D0304171 CLIA NUMBER - DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH, LLC

Laboratory Demographics

  • Code: 01D0304171
  • Facility Name: DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH, LLC
  • Facility Address: 11123 CHANTILLY PARKWAY UNIT L
    PIKE ROAD, AL
    ZIP 36064
  • Facility Phone: 334 270-1151
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • NPI Number: 1013946722
  • Taxonomy: 251E00000X - Home Health
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CLIA Record

Field Name Field Value
CLIA Number 01D0304171
LAB Type Home Health Agency
Facility Name DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH, LLC
Street 11123 CHANTILLY PARKWAY UNIT L
City PIKE ROAD
State AL
ZIP 36064
Phone 334 270-1151
Certificate Type 4
Certificate Effective Date 9/1/2022
Certificate Expiration Date 8/31/2024
Facility Type Waiver

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This page was last updated on: 4/23/2024