11D2326792 CLIA NUMBER - BLUE RIDGE CARE CENTER, LLC DBA PAULDING CARE CENTER NUSING & REHABILITATION

Laboratory Demographics

  • CLIA Code: 11D2326792
  • Facility Name: BLUE RIDGE CARE CENTER, LLC DBA PAULDING CARE CENTER NUSING & REHABILITATION
  • Facility Address: 600 W MEMORIAL DRIVE
    DALLAS, GA
    ZIP 30132
  • Facility Phone: 770 443-4411
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHAWNA L. DEGASTO
  • NPI Number: 1700602372
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2326792
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BLUE RIDGE CARE CENTER, LLC DBA PAULDING CARE CENTER NUSING & REHABILITATION
Street 600 W MEMORIAL DRIVE
City DALLAS
State GA
ZIP 30132
Phone 770 443-4411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHAWNA L. DEGASTO

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