16D2196199 CLIA NUMBER - HOLY SPIRIT RETIREMENT HOME

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Laboratory Demographics

CLIA Number: 16D2196199

Facility Name: HOLY SPIRIT RETIREMENT HOME

Facility Address:
1705 W 25TH STREET
SIOUX CITY, IA
ZIP 51103
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Facility Phone Number: 712 224-9974

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1508855271

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	16D2196199
LAB Type	Assisted Living Facility
Facility Name	HOLY SPIRIT RETIREMENT HOME
Street	1705 W 25TH STREET
City	SIOUX CITY
State	IA
ZIP	51103
Phone	712 224-9974
CertificateType	4
CertificateEffectiveDate	10/15/2022
CertificateExpirationDate	10/14/2024
FacilityType	Waiver

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