11D0963022 CLIA NUMBER - GOLDEN SOUTH ASSISTED LIVING

Laboratory Demographics

CLIA Number: 11D0963022

Facility Name: GOLDEN SOUTH ASSISTED LIVING

Facility Address:
705 DENHAM ROAD
SYCAMORE, GA
ZIP 31790
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Facility Phone Number: 912 567-4273

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1902964935

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	11D0963022
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	GOLDEN SOUTH ASSISTED LIVING
Street	705 DENHAM ROAD
City	SYCAMORE
State	GA
ZIP	31790
Phone	912 567-4273
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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