25D2041520 CLIA NUMBER - COVENANT PALLIATIVE AND HOSPICE LLC DBA HALCYON HOSPICE - PHILADELPHIA

Laboratory Demographics

  • CLIA Code: 25D2041520
  • Facility Name: COVENANT PALLIATIVE AND HOSPICE LLC DBA HALCYON HOSPICE - PHILADELPHIA
  • Facility Address: 1120 EAST MAIN STREET, SUITE 13
    PHILADELPHIA, MS
    ZIP 39350
  • Facility Phone: 601 656-7411
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: RANDI L. SHAFER
  • NPI Number: 1083963979
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 25D2041520
LAB Type Hospice
Facility Name COVENANT PALLIATIVE AND HOSPICE LLC DBA HALCYON HOSPICE - PHILADELPHIA
Street 1120 EAST MAIN STREET, SUITE 13
City PHILADELPHIA
State MS
ZIP 39350
Phone 601 656-7411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Hospice
Lab Director RANDI L. SHAFER

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