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11D1078956 CLIA NUMBER - AMEDISYS HOSPICE LLC D/B/A AMEDISYS HOSPICE CARE OF KENNESAW

Laboratory Demographics

CLIA Number: 11D1078956

Facility Name: AMEDISYS HOSPICE LLC D/B/A AMEDISYS HOSPICE CARE OF KENNESAW

Facility Address:
4425 WADE GREEN RD NW, BLDG 300, SUITE 320
KENNESAW, GA
ZIP 30144
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Facility Phone Number: 770 423-1316

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1396938015

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name Field Value
CLIA Number 11D1078956
LAB Type Home Health Agency
Facility Name AMEDISYS HOSPICE LLC D/B/A AMEDISYS HOSPICE CARE OF KENNESAW
Street 4425 WADE GREEN RD NW, BLDG 300, SUITE 320
City KENNESAW
State GA
ZIP 30144
Phone 770 423-1316
CertificateType 4
CertificateEffectiveDate 1/18/2024
CertificateExpirationDate 1/17/2026
FacilityType Waiver

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