39D2051249 CLIA NUMBER - SOUTHERNCARE, INC D/B/A GENTIVA II

Laboratory Demographics

  • CLIA Code: 39D2051249
  • Facility Name: SOUTHERNCARE, INC D/B/A GENTIVA II
  • Facility Address: 1701 12TH AVENUE, BUILDING D
    ALTOONA, PA
    ZIP 16602
  • Facility Phone: 205 868-4426
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE BEASLEY
  • NPI Number: 1700826211
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 39D2051249
LAB Type Hospice
Facility Name SOUTHERNCARE, INC D/B/A GENTIVA II
Street 1701 12TH AVENUE, BUILDING D
City ALTOONA
State PA
ZIP 16602
Phone 205 868-4426
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Hospice
Lab Director SELECE BEASLEY

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