01D0304772 CLIA NUMBER - DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH AGENCY, LLC

Laboratory Demographics

  • CLIA Code: 01D0304772
  • Facility Name: DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH AGENCY, LLC
  • Facility Address: 1239 RUCKER BLVD
    ENTERPRISE, AL
    ZIP 36330
  • Facility Phone: 334 347-0234
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: SHASTA ALEXANDER
  • NPI Number: 1174552939
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 01D0304772
LAB Type Home Health Agency
Facility Name DBA CENTERWELL HOME HEALTH MID-SOUTH HOME HEALTH AGENCY, LLC
Street 1239 RUCKER BLVD
City ENTERPRISE
State AL
ZIP 36330
Phone 334 347-0234
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Home Health Agency
Lab Director SHASTA ALEXANDER

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This page was last updated on: 6/4/2025