25D0992347 CLIA NUMBER - MERCY HOSPICE LLC DBA LEGACY HOSPICE OF THE SOUTH

Laboratory Demographics

CLIA Number: 25D0992347

Facility Name: MERCY HOSPICE LLC DBA LEGACY HOSPICE OF THE SOUTH

Facility Address:
212 E JEFFERSON ST
RIPLEY, MS
ZIP 38663
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Facility Phone Number: 662 837-9990

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1386689016

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	25D0992347
LAB Type	Hospice
Facility Name	MERCY HOSPICE LLC DBA LEGACY HOSPICE OF THE SOUTH
Street	212 E JEFFERSON ST
City	RIPLEY
State	MS
ZIP	38663
Phone	662 837-9990
CertificateType	4
CertificateEffectiveDate	10/15/2023
CertificateExpirationDate	10/14/2025
FacilityType	Waiver

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