01D1049391 CLIA NUMBER - WIREGRASS HOSPICE LLC DBA GENTIVA

Laboratory Demographics

  • CLIA Code: 01D1049391
  • Facility Name: WIREGRASS HOSPICE LLC DBA GENTIVA
  • Facility Address: 2431 W MAIN STREET, SUITE 1102
    DOTHAN, AL
    ZIP 36301
  • Facility Phone: 704 664-2876
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE BEASLEY
  • NPI Number: 1568635472
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 01D1049391
LAB Type Hospice
Facility Name WIREGRASS HOSPICE LLC DBA GENTIVA
Street 2431 W MAIN STREET, SUITE 1102
City DOTHAN
State AL
ZIP 36301
Phone 704 664-2876
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Hospice
Lab Director SELECE BEASLEY

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