16D2070408 CLIA NUMBER - SOUTHCREST MANOR II

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Laboratory Demographics

CLIA Number: 16D2070408

Facility Name: SOUTHCREST MANOR II

Facility Address:
602 2ND STREET SW
WAUKON, IA
ZIP 52172
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Facility Phone Number: 563 568-4207

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1952738502

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	16D2070408
LAB Type	Assisted Living Facility
Facility Name	SOUTHCREST MANOR II
Street	602 2ND STREET SW
City	WAUKON
State	IA
ZIP	52172
Phone	563 568-4207
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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