25D0691302 CLIA NUMBER - SHADY LAWN LLC DBA SHADY LAWN HEALTH AND REHABILITATION

Laboratory Demographics

  • CLIA Code: 25D0691302
  • Facility Name: SHADY LAWN LLC DBA SHADY LAWN HEALTH AND REHABILITATION
  • Facility Address: 60 SHADY LAWN PLACE
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 636-1448
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LARRY J. WILLIAMS
  • NPI Number: 1184613143
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0691302
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SHADY LAWN LLC DBA SHADY LAWN HEALTH AND REHABILITATION
Street 60 SHADY LAWN PLACE
City VICKSBURG
State MS
ZIP 39180
Phone 601 636-1448
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 LARRY J. WILLIAMS

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