25D2009497 CLIA NUMBER - SPECIALIZED TREATMENT FACILITY

Laboratory Demographics

  • CLIA Code: 25D2009497
  • Facility Name: SPECIALIZED TREATMENT FACILITY
  • Facility Address: 14426 JAMES BOND ROAD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 328-6000
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHANNON Y. BUSH
  • NPI Number: 1013922954
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D2009497
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SPECIALIZED TREATMENT FACILITY
Street 14426 JAMES BOND ROAD
City GULFPORT
State MS
ZIP 39503
Phone 228 328-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHANNON Y. BUSH

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