11D2155761 CLIA NUMBER - WIREGRASS HOSPICE, LLC DBA GENTIVA

Laboratory Demographics

  • CLIA Code: 11D2155761
  • Facility Name: WIREGRASS HOSPICE, LLC DBA GENTIVA
  • Facility Address: 432 EAST SHOTWELL STREET
    BAINBRIDGE, GA
    ZIP 39819
  • Facility Phone: 706 662-0416
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE BEASLEY
  • NPI Number: 1063448645
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 11D2155761
LAB Type Hospice
Facility Name WIREGRASS HOSPICE, LLC DBA GENTIVA
Street 432 EAST SHOTWELL STREET
City BAINBRIDGE
State GA
ZIP 39819
Phone 706 662-0416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Hospice
Lab Director SELECE BEASLEY

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