42D0990320 CLIA NUMBER - LONGWOOD PLANTATION-FHE, LLC

Laboratory Demographics

  • CLIA Code: 42D0990320
  • Facility Name: LONGWOOD PLANTATION-FHE, LLC
  • Facility Address: 1687 LONGWOOD DRIVE
    ORANGEBURG, SC
    ZIP 29118
  • Facility Phone: 803 535-0250
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: CLAY FOWLER
  • NPI Number: 1053576645
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 42D0990320
LAB Type Other
Facility Name LONGWOOD PLANTATION-FHE, LLC
Street 1687 LONGWOOD DRIVE
City ORANGEBURG
State SC
ZIP 29118
Phone 803 535-0250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2025
Certificate Expiration Date 8/19/2027
Facility Type Other
Lab Director CLAY FOWLER

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