11D1047460 CLIA NUMBER - HARBOR GRACE HOSPICE

Laboratory Demographics

  • CLIA Code: 11D1047460
  • Facility Name: HARBOR GRACE HOSPICE
  • Facility Address: 500 LANIER AVENUE WEST, SUITE 401
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 962-5850
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: TOREY B. CLARK
  • NPI Number: 1205960473
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D1047460
LAB Type Hospice
Facility Name HARBOR GRACE HOSPICE
Street 500 LANIER AVENUE WEST, SUITE 401
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 962-5850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Hospice
Lab Director TOREY B. CLARK

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