25D2267789 CLIA NUMBER - WILLOWOOD DEVELOPMENTAL CENTER

Laboratory Demographics

  • CLIA Code: 25D2267789
  • Facility Name: WILLOWOOD DEVELOPMENTAL CENTER
  • Facility Address: 1635 BOLING ST
    JACKSON, MS
    ZIP 39213
  • Facility Phone: 601 366-0123
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: KAREN J. DAY
  • NPI Number: 1174991855
  • Taxonomy: 251C00000X - Day Training, Developmentally Disabled Services

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2267789
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name WILLOWOOD DEVELOPMENTAL CENTER
Street 1635 BOLING ST
City JACKSON
State MS
ZIP 39213
Phone 601 366-0123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director KAREN J. DAY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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