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01D0677706 CLIA NUMBER - DBA CENTERWELL HOME HEALTH CHATTAHOOCHEE VALLEY HOME HEALTH, LLC

Laboratory Demographics

CLIA Number: 01D0677706

Facility Name: DBA CENTERWELL HOME HEALTH CHATTAHOOCHEE VALLEY HOME HEALTH, LLC

Facility Address:
5009 RIVER CHASE DR BLDG 100 SUITE D
PHENIX CITY, AL
ZIP 36867
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Facility Phone Number: 334 297-6900

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1336170570

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 01D0677706
LAB Type Home Health Agency
Facility Name DBA CENTERWELL HOME HEALTH CHATTAHOOCHEE VALLEY HOME HEALTH, LLC
Street 5009 RIVER CHASE DR BLDG 100 SUITE D
City PHENIX CITY
State AL
ZIP 36867
Phone 334 297-6900
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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