34D0981208 CLIA NUMBER - EVEREST LONG TERM CARE, LLC DBA LAKE PARK NURSING AND REHAB CENTER

Laboratory Demographics

  • CLIA Code: 34D0981208
  • Facility Name: EVEREST LONG TERM CARE, LLC DBA LAKE PARK NURSING AND REHAB CENTER
  • Facility Address: 3315 FAITH CHURCH RD
    INDIAN TRAIL, NC
    ZIP 28079
  • Facility Phone: 704 882-3420
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LISA D. HOLLOMAN
  • NPI Number: 1548206907
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D0981208
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVEREST LONG TERM CARE, LLC DBA LAKE PARK NURSING AND REHAB CENTER
Street 3315 FAITH CHURCH RD
City INDIAN TRAIL
State NC
ZIP 28079
Phone 704 882-3420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LISA D. HOLLOMAN

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