42D1023076 CLIA NUMBER - IVY GROVE RESIDENTIAL CENTER

Laboratory Demographics

  • CLIA Code: 42D1023076
  • Facility Name: IVY GROVE RESIDENTIAL CENTER
  • Facility Address: 483 LOCKHART LANE
    GAFFNEY, SC
    ZIP 29341
  • Facility Phone: 864 487-0869
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: OBIAJULU E. MELEKWE
  • NPI Number: 1144404823
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 42D1023076
LAB Type Other
Facility Name IVY GROVE RESIDENTIAL CENTER
Street 483 LOCKHART LANE
City GAFFNEY
State SC
ZIP 29341
Phone 864 487-0869
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Other
Lab Director OBIAJULU E. MELEKWE

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