11D0264317 CLIA NUMBER - MACON OPERATION, LLC DBA FOUNTAIN BLUE REHAB AND NURSING

Laboratory Demographics

  • CLIA Code: 11D0264317
  • Facility Name: MACON OPERATION, LLC DBA FOUNTAIN BLUE REHAB AND NURSING
  • Facility Address: 3051 WHITESIDE ROAD
    MACON, GA
    ZIP 31206
  • Facility Phone: 478 788-1421
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRENDALYN GOODE
  • NPI Number: 1447775655
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0264317
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MACON OPERATION, LLC DBA FOUNTAIN BLUE REHAB AND NURSING
Street 3051 WHITESIDE ROAD
City MACON
State GA
ZIP 31206
Phone 478 788-1421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director BRENDALYN GOODE

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