17D0648203 CLIA NUMBER - PROVIDENCE PLACE

Laboratory Demographics

  • CLIA Code: 17D0648203
  • Facility Name: PROVIDENCE PLACE
  • Facility Address: 8909 PARALLEL PKWY
    KANSAS CITY, KS
    ZIP 66112
  • Facility Phone: 913 596-4200
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SRINATH TADAKAMALLA
  • NPI Number: 1750385217
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0648203
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROVIDENCE PLACE
Street 8909 PARALLEL PKWY
City KANSAS CITY
State KS
ZIP 66112
Phone 913 596-4200
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 SRINATH TADAKAMALLA

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