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

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Laboratory Demographics

CLIA Number: 39D2051249

Facility Name: SOUTHERNCARE, INC D/B/A GENTIVA II

Facility Address:
1701 12TH AVENUE, BUILDING D
ALTOONA, PA
ZIP 16602
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Facility Phone Number: 205 868-4426

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1700826211

Taxonomy: 251G00000X - Hospice Care, Community Based

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
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024