34D2019494 CLIA NUMBER - ROSE TARA PLANTATION

Laboratory Demographics

  • CLIA Code: 34D2019494
  • Facility Name: ROSE TARA PLANTATION
  • Facility Address: 125 PLANTATIOIN DRIVE
    KING, NC
    ZIP 27021
  • Facility Phone: 336 983-8929
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRENDA Y. PEDDYCORD
  • NPI Number: 1902822182
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2019494
LAB Type Assisted Living Facility
Facility Name ROSE TARA PLANTATION
Street 125 PLANTATIOIN DRIVE
City KING
State NC
ZIP 27021
Phone 336 983-8929
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Assisted Living Facility
Lab Director BRENDA Y. PEDDYCORD

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