11D2125695 CLIA NUMBER - VICTORY VILLAGE, PCH

Laboratory Demographics

  • CLIA Code: 11D2125695
  • Facility Name: VICTORY VILLAGE, PCH
  • Facility Address: 3650 SALEM CHURCH ROAD
    JASPER, GA
    ZIP 30143
  • Facility Phone: 770 735-2219
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TAMMY CRIDER KINDLE
  • NPI Number: 1912409137
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2125695
LAB Type Assisted Living Facility
Facility Name VICTORY VILLAGE, PCH
Street 3650 SALEM CHURCH ROAD
City JASPER
State GA
ZIP 30143
Phone 770 735-2219
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Assisted Living Facility
Lab Director TAMMY CRIDER KINDLE

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