11D0263569 CLIA NUMBER - FORT VALLEY HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 11D0263569
  • Facility Name: FORT VALLEY HEALTHCARE CENTER
  • Facility Address: 604 BLUEBIRD BOULEVARD
    FORT VALLEY, GA
    ZIP 31030
  • Facility Phone: 478 825-2031
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JENNIFER P. JOHNSON
  • NPI Number: 1376604082
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0263569
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FORT VALLEY HEALTHCARE CENTER
Street 604 BLUEBIRD BOULEVARD
City FORT VALLEY
State GA
ZIP 31030
Phone 478 825-2031
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 JENNIFER P. JOHNSON

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