17D0950654 CLIA NUMBER - HOMESTEAD OF DERBY

Laboratory Demographics

CLIA Number: 17D0950654

Facility Name: HOMESTEAD OF DERBY

Facility Address:
1701 WALNUT GROVE ROAD
DERBY, KS
ZIP 67037
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Facility Phone Number: 316 788-9600

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1700321486

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	17D0950654
LAB Type	Assisted Living Facility
Facility Name	HOMESTEAD OF DERBY
Street	1701 WALNUT GROVE ROAD
City	DERBY
State	KS
ZIP	67037
Phone	316 788-9600
CertificateType	4
CertificateEffectiveDate	9/8/2022
CertificateExpirationDate	9/7/2024
FacilityType	Waiver

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