25D2032130 CLIA NUMBER - FAMILY HEALTH CARE CLINIC INC NEW ZION HEAD START

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Laboratory Demographics

CLIA Number: 25D2032130

Facility Name: FAMILY HEALTH CARE CLINIC INC NEW ZION HEAD START

Facility Address:
2506 HIGHWAY 51 SE
BOGUE CHITTO, MS
ZIP 39629
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Facility Phone Number: 601 823-1710

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1033342134

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2032130
LAB Type	School/Student Health Service
Facility Name	FAMILY HEALTH CARE CLINIC INC NEW ZION HEAD START
Street	2506 HIGHWAY 51 SE
City	BOGUE CHITTO
State	MS
ZIP	39629
Phone	601 823-1710
CertificateType	4
CertificateEffectiveDate	11/4/2023
CertificateExpirationDate	11/3/2025
FacilityType	Waiver

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