34D0979176 CLIA NUMBER - AUTUMN CARE OF MYRTLE GROVE

Laboratory Demographics

  • CLIA Code: 34D0979176
  • Facility Name: AUTUMN CARE OF MYRTLE GROVE
  • Facility Address: 5725 CAROLINA BEACH RD
    WILMINGTON, NC
    ZIP 28412
  • Facility Phone: (910) 123-4567
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ROBERT WOODIE
  • NPI Number: 1073599635
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D0979176
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN CARE OF MYRTLE GROVE
Street 5725 CAROLINA BEACH RD
City WILMINGTON
State NC
ZIP 28412
Phone 9101234567
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2024
Certificate Expiration Date 10/15/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ROBERT WOODIE

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This page was last updated on: 5/18/2026