11D0256786 CLIA NUMBER - FIFTH AVENUE HEALTH CARE

Laboratory Demographics

  • CLIA Code: 11D0256786
  • Facility Name: FIFTH AVENUE HEALTH CARE
  • Facility Address: 505 NORTH FIFTH AVE
    ROME, GA
    ZIP 30165
  • Facility Phone: 706 291-0521
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CHARLES BETZ
  • NPI Number: 1760483606
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0256786
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FIFTH AVENUE HEALTH CARE
Street 505 NORTH FIFTH AVE
City ROME
State GA
ZIP 30165
Phone 706 291-0521
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 Skilled Nursing Facility/Nursing Facility
Lab Director CHARLES BETZ

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