25D0893823 CLIA NUMBER - JEFFERSON COUNTY NURSING HOME

Laboratory Demographics

  • CLIA Code: 25D0893823
  • Facility Name: JEFFERSON COUNTY NURSING HOME
  • Facility Address: 910 MAIN STREET
    FAYETTE, MS
    ZIP 39069
  • Facility Phone: 601 786-3888
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PATRICIA PERRYMAN
  • NPI Number: 1184611741
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0893823
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name JEFFERSON COUNTY NURSING HOME
Street 910 MAIN STREET
City FAYETTE
State MS
ZIP 39069
Phone 601 786-3888
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director PATRICIA PERRYMAN

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