17D0451123 CLIA NUMBER - MOUNDRIDGE MANOR

Laboratory Demographics

  • CLIA Code: 17D0451123
  • Facility Name: MOUNDRIDGE MANOR
  • Facility Address: 710 N CHRISTIAN AVE
    MOUNDRIDGE, KS
    ZIP 67107
  • Facility Phone: 620 345-6364
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LEAH NIGHTINGALE
  • NPI Number: 1972578037
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LEAH NIGHTINGALE

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