25D1071084 CLIA NUMBER - WISTERIA GARDENS LLC

Laboratory Demographics

  • CLIA Code: 25D1071084
  • Facility Name: WISTERIA GARDENS LLC
  • Facility Address: 5420 HWY 80 EAST
    PEARL, MS
    ZIP 39208
  • Facility Phone: 601 624-2498
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DAVID HILL
  • NPI Number: 1306031372
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D1071084
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name WISTERIA GARDENS LLC
Street 5420 HWY 80 EAST
City PEARL
State MS
ZIP 39208
Phone 601 624-2498
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DAVID HILL

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