25D2310069 CLIA NUMBER - SECOND CHANCE HEALTHCARE LLC

Laboratory Demographics

  • CLIA Code: 25D2310069
  • Facility Name: SECOND CHANCE HEALTHCARE LLC
  • Facility Address: 405 RIVER ROAD
    GREENWOOD, MS
    ZIP 38930
  • Facility Phone: 662 304-8805
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CHAKITA L. BEVERLY
  • NPI Number: 1548099765
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2310069
LAB Type Practitioner Other
Facility Name SECOND CHANCE HEALTHCARE LLC
Street 405 RIVER ROAD
City GREENWOOD
State MS
ZIP 38930
Phone 662 304-8805
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Practitioner Other
Lab Director CHAKITA L. BEVERLY

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