17D0451374 CLIA NUMBER - LIFE CARE CENTER OF ANDOVER

Laboratory Demographics

  • CLIA Code: 17D0451374
  • Facility Name: LIFE CARE CENTER OF ANDOVER
  • Facility Address: 621 WEST 21ST STREET
    ANDOVER, KS
    ZIP 67002
  • Facility Phone: 316 733-1349
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DEDRA COLEMAN
  • NPI Number: 1194771410
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0451374
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LIFE CARE CENTER OF ANDOVER
Street 621 WEST 21ST STREET
City ANDOVER
State KS
ZIP 67002
Phone 316 733-1349
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 DEDRA COLEMAN

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This page was last updated on: 6/4/2025