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17D0451123 CLIA NUMBER - MOUNDRIDGE MANOR

Laboratory Demographics

CLIA Number: 17D0451123

Facility Name: MOUNDRIDGE MANOR

Facility Address:
710 N CHRISTIAN AVE
MOUNDRIDGE, KS
ZIP 67107
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Facility Phone Number: 620 345-6364

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1972578037

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name Field Value
CLIA Number 17D0451123
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MOUNDRIDGE MANOR
Street 710 N CHRISTIAN AVE
City MOUNDRIDGE
State KS
ZIP 67107
Phone 620 345-6364
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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