25D0672424 CLIA NUMBER - DIVERSICARE OF MOSS POINT

Laboratory Demographics

  • CLIA Code: 25D0672424
  • Facility Name: DIVERSICARE OF MOSS POINT
  • Facility Address: 3401 MAIN STREET
    MOSS POINT, MS
    ZIP 39563
  • Facility Phone: 228 762-7451
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JASON B. CREEL
  • NPI Number: 1124288949
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0672424
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name DIVERSICARE OF MOSS POINT
Street 3401 MAIN STREET
City MOSS POINT
State MS
ZIP 39563
Phone 228 762-7451
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 JASON B. CREEL

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