17D0891850 CLIA NUMBER - PRAIRIE MISSION RETIREMENT VILLAGE

Laboratory Demographics

  • CLIA Code: 17D0891850
  • Facility Name: PRAIRIE MISSION RETIREMENT VILLAGE
  • Facility Address: 242 CARROLL ST
    ST PAUL, KS
    ZIP 66771
  • Facility Phone: 620 449-2400
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NIKI MICHAEL
  • NPI Number: 1134159452
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0891850
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PRAIRIE MISSION RETIREMENT VILLAGE
Street 242 CARROLL ST
City ST PAUL
State KS
ZIP 66771
Phone 620 449-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2024
Certificate Expiration Date 9/18/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NIKI MICHAEL

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