49D1015694 CLIA NUMBER - 803 SOUTH MAIN STREET OPCO LLC

Laboratory Demographics

  • CLIA Code: 49D1015694
  • Facility Name: 803 SOUTH MAIN STREET OPCO LLC
  • Facility Address: 803 S MAIN STREET
    WOODSTOCK, VA
    ZIP 22664
  • Facility Phone: 540 459-5676
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MALIA A. TAYLOR
  • NPI Number: 1942214176
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 49D1015694
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name 803 SOUTH MAIN STREET OPCO LLC
Street 803 S MAIN STREET
City WOODSTOCK
State VA
ZIP 22664
Phone 540 459-5676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MALIA A. TAYLOR

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