11D0999614 CLIA NUMBER - PRUITTHEALTH - JASPER, LLC FDBA MOUNTAIN HEALTHCARE CENTER, INC

Laboratory Demographics

  • CLIA Code: 11D0999614
  • Facility Name: PRUITTHEALTH - JASPER, LLC FDBA MOUNTAIN HEALTHCARE CENTER, INC
  • Facility Address: 1350 EAST CHURCH STREET
    JASPER, GA
    ZIP 30143
  • Facility Phone: 706 253-2441
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CHARLES FALLAW
  • NPI Number: 1770530297
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D0999614
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRUITTHEALTH - JASPER, LLC FDBA MOUNTAIN HEALTHCARE CENTER, INC
Street 1350 EAST CHURCH STREET
City JASPER
State GA
ZIP 30143
Phone 706 253-2441
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CHARLES FALLAW

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