42D2299791 CLIA NUMBER - SOUTHSIDE MANOR

Laboratory Demographics

  • CLIA Code: 42D2299791
  • Facility Name: SOUTHSIDE MANOR
  • Facility Address: 311 MANNING AVENUE
    SUMTER, SC
    ZIP 29150
  • Facility Phone: 803 236-1578
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: IDA L. GOLDEN
  • NPI Number: 1821818329
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 42D2299791
LAB Type Assisted Living Facility
Facility Name SOUTHSIDE MANOR
Street 311 MANNING AVENUE
City SUMTER
State SC
ZIP 29150
Phone 803 236-1578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Assisted Living Facility
Lab Director IDA L. GOLDEN

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