44D0934653 CLIA NUMBER - MARYVILLE FAIRPARK OPCO LLC

Laboratory Demographics

  • CLIA Code: 44D0934653
  • Facility Name: MARYVILLE FAIRPARK OPCO LLC
  • Facility Address: 307 NORTH FIFTH ST
    MARYVILLE, TN
    ZIP 37804
  • Facility Phone: (423) 983-0261
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: AMANDA OVERHOLT
  • NPI Number: 1528627791
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 44D0934653
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MARYVILLE FAIRPARK OPCO LLC
Street 307 NORTH FIFTH ST
City MARYVILLE
State TN
ZIP 37804
Phone 4239830261
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director AMANDA OVERHOLT

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This page was last updated on: 5/18/2026