10D2090232 CLIA NUMBER - AZALEA TRACE PHYSICIAN SERVICES

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Laboratory Demographics

CLIA Number: 10D2090232

Facility Name: AZALEA TRACE PHYSICIAN SERVICES

Facility Address:
10100 HILLVIEW DR
PENSACOLA, FL
ZIP 32514
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Facility Phone Number: 850 857-4958

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417292251

Taxonomy: 253Z00000X - In Home Supportive Care
An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves.

CLIA Record

Field Name	Field Value
CLIA Number	10D2090232
LAB Type	Physician Office
Facility Name	AZALEA TRACE PHYSICIAN SERVICES
Street	10100 HILLVIEW DR
City	PENSACOLA
State	FL
ZIP	32514
Phone	850 857-4958
CertificateType	4
CertificateEffectiveDate	1/16/2023
CertificateExpirationDate	1/15/2025
FacilityType	Waiver

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