34D2017300 CLIA NUMBER - CLEMMONS VILLAGE I

Laboratory Demographics

  • CLIA Code: 34D2017300
  • Facility Name: CLEMMONS VILLAGE I
  • Facility Address: 6401 HOLDER ROAD
    CLEMMONS, NC
    ZIP 27012
  • Facility Phone: 336 766-2990
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KATHY EDENS-BRIGGS
  • NPI Number: 1013008234
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2017300
LAB Type Assisted Living Facility
Facility Name CLEMMONS VILLAGE I
Street 6401 HOLDER ROAD
City CLEMMONS
State NC
ZIP 27012
Phone 336 766-2990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Assisted Living Facility
Lab Director KATHY EDENS-BRIGGS

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