16D1050268 CLIA NUMBER - PRAIRIE HILLS AT INDEPENDENCE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 16D1050268
  • Facility Name: PRAIRIE HILLS AT INDEPENDENCE ASSISTED LIVING
  • Facility Address: 505 ENTERPRISE DRIVE SW
    INDEPENDENCE, IA
    ZIP 50644
  • Facility Phone: 319 334-2000
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: VICKY M. RUSTHOVEN
  • NPI Number: 1760698039
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 16D1050268
LAB Type Assisted Living Facility
Facility Name PRAIRIE HILLS AT INDEPENDENCE ASSISTED LIVING
Street 505 ENTERPRISE DRIVE SW
City INDEPENDENCE
State IA
ZIP 50644
Phone 319 334-2000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Assisted Living Facility
Lab Director VICKY M. RUSTHOVEN

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