17D2076304 CLIA NUMBER - VICTORIA FALLS

Laboratory Demographics

  • CLIA Code: 17D2076304
  • Facility Name: VICTORIA FALLS
  • Facility Address: 408 EAST CENTRAL
    ANDOVER, KS
    ZIP 67002
  • Facility Phone: 316 733-0334
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DENNIS L. BUSH
  • NPI Number: 1992850432
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D2076304
LAB Type Assisted Living Facility
Facility Name VICTORIA FALLS
Street 408 EAST CENTRAL
City ANDOVER
State KS
ZIP 67002
Phone 316 733-0334
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2024
Certificate Expiration Date 10/18/2026
Facility Type Assisted Living Facility
Lab Director DENNIS L. BUSH

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