25D0669514 CLIA NUMBER - DIVERSICARE OF SHELBY

Laboratory Demographics

  • CLIA Code: 25D0669514
  • Facility Name: DIVERSICARE OF SHELBY
  • Facility Address: 1108 CHURCH STREET
    SHELBY, MS
    ZIP 38774
  • Facility Phone: 662 398-5117
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ZINA CHRISTIAN
  • NPI Number: 1902066202
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0669514
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name DIVERSICARE OF SHELBY
Street 1108 CHURCH STREET
City SHELBY
State MS
ZIP 38774
Phone 662 398-5117
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 ZINA CHRISTIAN

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