11D2034041 CLIA NUMBER - ST JOSEPH HOSPICE, LLC

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Laboratory Demographics

CLIA Number: 11D2034041

Facility Name: ST JOSEPH HOSPICE, LLC

Facility Address:
1220 GEORGE C WILSON DRIVE
AUGUSTA, GA
ZIP 30909
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Facility Phone Number: 706 922-7480

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1275836082

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	11D2034041
LAB Type	Hospice
Facility Name	ST JOSEPH HOSPICE, LLC
Street	1220 GEORGE C WILSON DRIVE
City	AUGUSTA
State	GA
ZIP	30909
Phone	706 922-7480
CertificateType	4
CertificateEffectiveDate	12/15/2023
CertificateExpirationDate	12/14/2025
FacilityType	Waiver

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