11D0898960 CLIA NUMBER - PARK PLACE NURSING FACILITY

Laboratory Demographics

  • CLIA Code: 11D0898960
  • Facility Name: PARK PLACE NURSING FACILITY
  • Facility Address: 1865 BOLD SPRINGS RD NW
    MONROE, GA
    ZIP 30656
  • Facility Phone: (770) 267-8677
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TASANDRA HYDERKHAN
  • NPI Number: 1972518611
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0898960
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PARK PLACE NURSING FACILITY
Street 1865 BOLD SPRINGS RD NW
City MONROE
State GA
ZIP 30656
Phone 7702678677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TASANDRA HYDERKHAN

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This page was last updated on: 5/18/2026