25D2072434 CLIA NUMBER - GULFPORT HEALTHCARE, LLC DBA GULFPORT CARE CENTER

Laboratory Demographics

  • CLIA Code: 25D2072434
  • Facility Name: GULFPORT HEALTHCARE, LLC DBA GULFPORT CARE CENTER
  • Facility Address: 11240 CANAL ROAD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 701-1500
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: WILLIAM S. TREVVETT
  • NPI Number: 1821033796
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 25D2072434
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GULFPORT HEALTHCARE, LLC DBA GULFPORT CARE CENTER
Street 11240 CANAL ROAD
City GULFPORT
State MS
ZIP 39503
Phone 228 701-1500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director WILLIAM S. TREVVETT

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