16D0972977 CLIA NUMBER - CRESTVIEW

Laboratory Demographics

CLIA Number: 16D0972977

Facility Name: CRESTVIEW

Facility Address:
1700 CLARK ST PO BOX 457
CHARLES CITY, IA
ZIP 50616
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Facility Phone Number: 641 228-4842

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1437211240

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	16D0972977
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CRESTVIEW
Street	1700 CLARK ST PO BOX 457
City	CHARLES CITY
State	IA
ZIP	50616
Phone	641 228-4842
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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