11D0265685 CLIA NUMBER - PRESBYTERIAN HOME INC

Laboratory Demographics

CLIA Number: 11D0265685

Facility Name: PRESBYTERIAN HOME INC

Facility Address:
1901 WEST SCREVEN ST
QUITMAN, GA
ZIP 31643
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Facility Phone Number: 912 263-6100

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1487713616

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	11D0265685
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	PRESBYTERIAN HOME INC
Street	1901 WEST SCREVEN ST
City	QUITMAN
State	GA
ZIP	31643
Phone	912 263-6100
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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