42D1064857 CLIA NUMBER - TIDEWATER DBA CRESCENT HOSPICE

Laboratory Demographics

  • CLIA Code: 42D1064857
  • Facility Name: TIDEWATER DBA CRESCENT HOSPICE
  • Facility Address: 10 BUCKINGHAM PLANTATION DRIVE, SUITE A
    BLUFFTON, SC
    ZIP 29910
  • Facility Phone: 843 757-9388
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: AMY WALL
  • NPI Number: 1205915188
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2025
Certificate Expiration Date 2/14/2027
Facility Type Hospice
Lab Director AMY WALL

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