25D2109400 CLIA NUMBER - PSYCAMORE PSYCHIATRIC PROGRAM, LLC

Laboratory Demographics

  • CLIA Code: 25D2109400
  • Facility Name: PSYCAMORE PSYCHIATRIC PROGRAM, LLC
  • Facility Address: 2620 EXECUTIVE PLACE
    BILOXI, MS
    ZIP 39531
  • Facility Phone: 601 939-5993
  • Facility Type: Other - BEHAVIORAL HLT PHP & IOP
  • Facility Type: Waiver
  • Lab Director: SUDHAKAR MADAKASIRA
  • NPI Number: 1699090001
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2109400
LAB Type Other - BEHAVIORAL HLT PHP & IOP
Facility Name PSYCAMORE PSYCHIATRIC PROGRAM, LLC
Street 2620 EXECUTIVE PLACE
City BILOXI
State MS
ZIP 39531
Phone 601 939-5993
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Other - BEHAVIORAL HLT PHP & IOP
Lab Director SUDHAKAR MADAKASIRA

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This page was last updated on: 3/20/2025