CLIA lab
CLIA 42D0901491: Lake Moultrie Nursing Home
Saint Stephen, SC. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 42D0901491 belongs to Lake Moultrie Nursing Home in Saint Stephen, SC.
Certificate of Waiver, effective May 30, 2025, expires May 29, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- May 30, 2025
- Certificate expiration
- May 29, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- May 30, 1995
- Facility type
- Skilled nursing or nursing facility
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 42D0901491
- Lab name
- Lake Moultrie Nursing Home
- Address
- 1038 Mcgill Lane, Saint Stephen, SC 29479
- Phone
- (843) 567-2307
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Care facility at this address
- Lake Moultrie Nursing HomeCMS Care Compare ratings for the facility at the same street address
Other labs in Saint Stephen, SC
Related
Questions
What is the CLIA number for Lake Moultrie Nursing Home in Saint Stephen?
42D0901491, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Lake Moultrie Nursing Home hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 42D0901491 expire?
The CMS file lists May 29, 2027 as the certificate expiration date; the certificate took effect May 30, 2025.