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

Laboratory Demographics

CLIA Number: 25D0691302

Facility Name: SHADY LAWN LLC DBA SHADY LAWN HEALTH AND REHABILITATION

Facility Address:
60 SHADY LAWN PLACE
VICKSBURG, MS
ZIP 39180
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Facility Phone Number: 601 636-1448

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1184613143

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

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
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024