23D2050594 CLIA NUMBER - SOUTHERNCARE, INC - JACKSON

Laboratory Demographics

  • CLIA Code: 23D2050594
  • Facility Name: SOUTHERNCARE, INC - JACKSON
  • Facility Address: 1965 BOARDMAN ROAD SUITE B
    JACKSON, MI
    ZIP 49202
  • Facility Phone: 704 662-0416
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: KELLY SANDERS
  • NPI Number: 1740229178
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 23D2050594
LAB Type Hospice
Facility Name SOUTHERNCARE, INC - JACKSON
Street 1965 BOARDMAN ROAD SUITE B
City JACKSON
State MI
ZIP 49202
Phone 704 662-0416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Hospice
Lab Director KELLY SANDERS

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