11D0672526 CLIA NUMBER - PHG MCRAE LLC DBA MCRAE MANOR NURSING HOME

Laboratory Demographics

  • CLIA Code: 11D0672526
  • Facility Name: PHG MCRAE LLC DBA MCRAE MANOR NURSING HOME
  • Facility Address: 160 S FIRST AVENUE
    MCRAE, GA
    ZIP 31055
  • Facility Phone: 229 868-6473
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRIAN D. SIDALL
  • NPI Number: 1033123682
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0672526
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PHG MCRAE LLC DBA MCRAE MANOR NURSING HOME
Street 160 S FIRST AVENUE
City MCRAE
State GA
ZIP 31055
Phone 229 868-6473
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 BRIAN D. SIDALL

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