25D0697511 CLIA NUMBER - FOREST AVENUE OPCO, LLC DBA PINE FOREST HEALTH AND REHABILITATION

Laboratory Demographics

  • CLIA Code: 25D0697511
  • Facility Name: FOREST AVENUE OPCO, LLC DBA PINE FOREST HEALTH AND REHABILITATION
  • Facility Address: 1116 FOREST AVENUE
    JACKSON, MS
    ZIP 39206
  • Facility Phone: 601 366-6461
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARGARET HEGGINS
  • NPI Number: 1396213492
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0697511
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FOREST AVENUE OPCO, LLC DBA PINE FOREST HEALTH AND REHABILITATION
Street 1116 FOREST AVENUE
City JACKSON
State MS
ZIP 39206
Phone 601 366-6461
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 MARGARET HEGGINS

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