42D1064857 CLIA NUMBER - TIDEWATER DBA CRESCENT HOSPICE

Laboratory Demographics

CLIA Number: 42D1064857

Facility Name: TIDEWATER DBA CRESCENT HOSPICE

Facility Address:
10 BUCKINGHAM PLANTATION DRIVE, SUITE A
BLUFFTON, SC
ZIP 29910
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Facility Phone Number: 843 757-9388

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1205915188

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	42D1064857
LAB Type	Hospice
Facility Name	TIDEWATER DBA CRESCENT HOSPICE
Street	10 BUCKINGHAM PLANTATION DRIVE, SUITE A
City	BLUFFTON
State	SC
ZIP	29910
Phone	843 757-9388
CertificateType	4
CertificateEffectiveDate	2/15/2023
CertificateExpirationDate	2/14/2025
FacilityType	Waiver

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