26D1017957 CLIA NUMBER - HOSPICE COMPASSUS-SOUTH CENTRAL MISSOURI

Laboratory Demographics

CLIA Number: 26D1017957

Facility Name: HOSPICE COMPASSUS-SOUTH CENTRAL MISSOURI

Facility Address:
1602C N MAIN STREET
MOUNTAIN GROVE, MO
ZIP 65711
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Facility Phone Number: 417 926-4146

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1376505230

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	26D1017957
LAB Type	Hospice
Facility Name	HOSPICE COMPASSUS-SOUTH CENTRAL MISSOURI
Street	1602C N MAIN STREET
City	MOUNTAIN GROVE
State	MO
ZIP	65711
Phone	417 926-4146
CertificateType	4
CertificateEffectiveDate	10/9/2023
CertificateExpirationDate	10/8/2025
FacilityType	Waiver

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