16D1088592 CLIA NUMBER - PARK PLACE INDEPENDENT & ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 16D1088592
  • Facility Name: PARK PLACE INDEPENDENT & ASSISTED LIVING
  • Facility Address: 551 PARK AVENUE
    SAC CITY, IA
    ZIP 50583
  • Facility Phone: 712 662-6260
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: VICTORIA SHULL
  • NPI Number: 1487983797
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 16D1088592
LAB Type Assisted Living Facility
Facility Name PARK PLACE INDEPENDENT & ASSISTED LIVING
Street 551 PARK AVENUE
City SAC CITY
State IA
ZIP 50583
Phone 712 662-6260
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Assisted Living Facility
Lab Director VICTORIA SHULL

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