25D2194187 CLIA NUMBER - BELLEVUE ASSISTED LIVING

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Laboratory Demographics

CLIA Number: 25D2194187

Facility Name: BELLEVUE ASSISTED LIVING

Facility Address:
34 GRAHAM RD
HATTIESBURG, MS
ZIP 39402
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Facility Phone Number: 601 818-2016

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1629300512

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2194187
LAB Type	Assisted Living Facility
Facility Name	BELLEVUE ASSISTED LIVING
Street	34 GRAHAM RD
City	HATTIESBURG
State	MS
ZIP	39402
Phone	601 818-2016
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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