25D2050524 CLIA NUMBER - SOUTHERNCARE INC DBA GENTIVA

Laboratory Demographics

  • CLIA Code: 25D2050524
  • Facility Name: SOUTHERNCARE INC DBA GENTIVA
  • Facility Address: 706 HWY 51 N
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 990-2315
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE BEASLEY
  • NPI Number: 1851330641
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 25D2050524
LAB Type Hospice
Facility Name SOUTHERNCARE INC DBA GENTIVA
Street 706 HWY 51 N
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 990-2315
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2024
Certificate Expiration Date 11/29/2026
Facility Type Hospice
Lab Director SELECE BEASLEY

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