25D0029775 CLIA NUMBER - BOSWELL REGIONAL CENTER CLINIC

Laboratory Demographics

CLIA Code: 25D0029775
Facility Name: BOSWELL REGIONAL CENTER CLINIC
Facility Address: 1049 SIMPSON HIGHWAY 149
MAGEE, MS
ZIP 39111
Facility Phone: 601 849-3321
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: TERESA WINDHAM
NPI Number: 1255890695
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	25D0029775
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BOSWELL REGIONAL CENTER CLINIC
Street	1049 SIMPSON HIGHWAY 149
City	MAGEE
State	MS
ZIP	39111
Phone	601 849-3321
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/1/2024
Certificate Expiration Date	8/31/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	TERESA WINDHAM

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