17D2200134 CLIA NUMBER - PRAIRIE HOMESTEAD ASSISSTED LIVING

Laboratory Demographics

  • CLIA Code: 17D2200134
  • Facility Name: PRAIRIE HOMESTEAD ASSISSTED LIVING
  • Facility Address: 1605 W MAY STREET
    WICHITA, KS
    ZIP 67213
  • Facility Phone: 316 263-8264
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRENDA K. JANDA
  • NPI Number: 1124342381
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D2200134
LAB Type Assisted Living Facility
Facility Name PRAIRIE HOMESTEAD ASSISSTED LIVING
Street 1605 W MAY STREET
City WICHITA
State KS
ZIP 67213
Phone 316 263-8264
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Assisted Living Facility
Lab Director BRENDA K. JANDA

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This page was last updated on: 9/29/2025