10D2199838 CLIA NUMBER - KELLY'S ASSISTED LIVING FACILITY

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Laboratory Demographics

CLIA Number: 10D2199838

Facility Name: KELLY'S ASSISTED LIVING FACILITY

Facility Address:
1451 NW 20TH ST
FORT LAUDERDALE, FL
ZIP 33311
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Facility Phone Number: 954 524-2867

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1881954659

Taxonomy: 3104A0625X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.

CLIA Record

Field Name	Field Value
CLIA Number	10D2199838
LAB Type	Assisted Living Facility
Facility Name	KELLY'S ASSISTED LIVING FACILITY
Street	1451 NW 20TH ST
City	FORT LAUDERDALE
State	FL
ZIP	33311
Phone	954 524-2867
CertificateType	4
CertificateEffectiveDate	11/11/2022
CertificateExpirationDate	11/10/2024
FacilityType	Waiver

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