34D2017123 CLIA NUMBER - PROVIDENCE GROUP HOME

Laboratory Demographics

  • CLIA Code: 34D2017123
  • Facility Name: PROVIDENCE GROUP HOME
  • Facility Address: 941 EAST SALISBURY STREET
    ASHEBORO, NC
    ZIP 27203
  • Facility Phone: 336 626-5884
  • Facility Type: Other - GROUP HOME
  • Facility Type: Waiver
  • Lab Director: STACY MASSEY
  • NPI Number: 1164468104
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2017123
LAB Type Other - GROUP HOME
Facility Name PROVIDENCE GROUP HOME
Street 941 EAST SALISBURY STREET
City ASHEBORO
State NC
ZIP 27203
Phone 336 626-5884
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Other - GROUP HOME
Lab Director STACY MASSEY

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