25D2079885 CLIA NUMBER - GULF COAST PEDIATRIC CARE, LLC

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Laboratory Demographics

CLIA Number: 25D2079885

Facility Name: GULF COAST PEDIATRIC CARE, LLC

Facility Address:
1285 SPRING STREET, SUITE B
GULFPORT, MS
ZIP 39507
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Facility Phone Number: 251 232-1518

Facility Type: Other - PRESCRIBED PEDIATRIC CARE

Certificate Type: Waiver

NPI Number: 1891107298

Taxonomy: 3140N1450X - Skilled Nursing Facility
A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.

CLIA Record

Field Name	Field Value
CLIA Number	25D2079885
LAB Type	Other - PRESCRIBED PEDIATRIC CARE
Facility Name	GULF COAST PEDIATRIC CARE, LLC
Street	1285 SPRING STREET, SUITE B
City	GULFPORT
State	MS
ZIP	39507
Phone	251 232-1518
CertificateType	4
CertificateEffectiveDate	6/26/2022
CertificateExpirationDate	6/25/2024
FacilityType	Waiver

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