34D2202873 CLIA NUMBER - MILL CREEK MANOR

Laboratory Demographics

  • CLIA Code: 34D2202873
  • Facility Name: MILL CREEK MANOR
  • Facility Address: 1902 ORA DRIVE
    STATESVILLE, NC
    ZIP 28625
  • Facility Phone: 980 223-2353
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JAMIE E. SMITH
  • NPI Number: 1689239923
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2202873
LAB Type Assisted Living Facility
Facility Name MILL CREEK MANOR
Street 1902 ORA DRIVE
City STATESVILLE
State NC
ZIP 28625
Phone 980 223-2353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Assisted Living Facility
Lab Director JAMIE E. SMITH

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