25D0317529 CLIA NUMBER - PINE CREST GUEST HOME

Laboratory Demographics

  • CLIA Code: 25D0317529
  • Facility Name: PINE CREST GUEST HOME
  • Facility Address: 133 PINE ST
    HAZLEHURST, MS
    ZIP 39083
  • Facility Phone: 601 894-1411
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: FRED MCDONALD MD
  • NPI Number: 1134116825
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0317529
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PINE CREST GUEST HOME
Street 133 PINE ST
City HAZLEHURST
State MS
ZIP 39083
Phone 601 894-1411
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 Skilled Nursing Facility/Nursing Facility
Lab Director FRED MCDONALD MD

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