42D2024306 CLIA NUMBER - LIGHTHOUSE HOSPICE GROUP, LLC

Laboratory Demographics

  • CLIA Code: 42D2024306
  • Facility Name: LIGHTHOUSE HOSPICE GROUP, LLC
  • Facility Address: 110 OAK PARK DRIVE, UNIT C
    IRMO, SC
    ZIP 29063
  • Facility Phone: 803 781-1935
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: NICOLE L. HOUDESHELL
  • NPI Number: 1295027159
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 42D2024306
LAB Type Hospice
Facility Name LIGHTHOUSE HOSPICE GROUP, LLC
Street 110 OAK PARK DRIVE, UNIT C
City IRMO
State SC
ZIP 29063
Phone 803 781-1935
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Hospice
Lab Director NICOLE L. HOUDESHELL

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