34D2329048 CLIA NUMBER - EASTERSEALS PORT HEALTH - JACKSONVILLE CRISIS CENTER

Laboratory Demographics

CLIA Code: 34D2329048
Facility Name: EASTERSEALS PORT HEALTH - JACKSONVILLE CRISIS CENTER
Facility Address: 215 B MEMORIAL DRIVE
JACKSONVILLE, NC
ZIP 28546
Facility Phone: 800 662-7119
Facility Type: Other - FACILITY BAASED CRISIS
Facility Type: Waiver
Lab Director: KIMBERLY MANNING
NPI Number: 1831244524
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	34D2329048
LAB Type	Other - FACILITY BAASED CRISIS
Facility Name	EASTERSEALS PORT HEALTH - JACKSONVILLE CRISIS CENTER
Street	215 B MEMORIAL DRIVE
City	JACKSONVILLE
State	NC
ZIP	28546
Phone	800 662-7119
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/21/2025
Certificate Expiration Date	8/20/2027
Facility Type	Other - FACILITY BAASED CRISIS
Lab Director	KIMBERLY MANNING

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