17D2150058 CLIA NUMBER - KELLY HOUSE TOPEKA #1

Laboratory Demographics

CLIA Number: 17D2150058

Facility Name: KELLY HOUSE TOPEKA #1

Facility Address:
2111 SW RANDOLPH AVENUE
TOPEKA, KS
ZIP 66611
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Facility Phone Number: 785 234-8888

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1841626041

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	17D2150058
LAB Type	Assisted Living Facility
Facility Name	KELLY HOUSE TOPEKA #1
Street	2111 SW RANDOLPH AVENUE
City	TOPEKA
State	KS
ZIP	66611
Phone	785 234-8888
CertificateType	4
CertificateEffectiveDate	6/15/2022
CertificateExpirationDate	6/14/2024
FacilityType	Waiver

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