44D0311171 CLIA NUMBER - HOLSTON MANOR SNF OPERATIONS LLC DBA HOLSTON REHABILITATION AND CARE CENTER

Laboratory Demographics

  • CLIA Code: 44D0311171
  • Facility Name: HOLSTON MANOR SNF OPERATIONS LLC DBA HOLSTON REHABILITATION AND CARE CENTER
  • Facility Address: 3641 MEMORIAL BLVD
    KINGSPORT, TN
    ZIP 37664
  • Facility Phone: 423 246-2411
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ANGELA SUMNER
  • NPI Number: 1669136123
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 44D0311171
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HOLSTON MANOR SNF OPERATIONS LLC DBA HOLSTON REHABILITATION AND CARE CENTER
Street 3641 MEMORIAL BLVD
City KINGSPORT
State TN
ZIP 37664
Phone 423 246-2411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ANGELA SUMNER

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