07D0868505 CLIA NUMBER - COMMUNITY RESIDENCES INC

Laboratory Demographics

CLIA Number: 07D0868505

Facility Name: COMMUNITY RESIDENCES INC

Facility Address:
732 WEST STREET
SOUTHINGTON, CT
ZIP 06489
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Facility Phone Number: 860 621-7600

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1902029341

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	07D0868505
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	COMMUNITY RESIDENCES INC
Street	732 WEST STREET
City	SOUTHINGTON
State	CT
ZIP	06489
Phone	860 621-7600
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024