17D2303576 CLIA NUMBER - KANSAS RENEWAL INSTITUTE

Laboratory Demographics

  • CLIA Code: 17D2303576
  • Facility Name: KANSAS RENEWAL INSTITUTE
  • Facility Address: 401 WOODLAND HILLS BLVD - KRI BOX #8
    FORT SCOTT, KS
    ZIP 66701
  • Facility Phone: 620 644-1195
  • Facility Type: Other - PRTF
  • Facility Type: Waiver
  • Lab Director: JODANNA L. SIMON
  • NPI Number: 1023876075
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D2303576
LAB Type Other - PRTF
Facility Name KANSAS RENEWAL INSTITUTE
Street 401 WOODLAND HILLS BLVD - KRI BOX #8
City FORT SCOTT
State KS
ZIP 66701
Phone 620 644-1195
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Other - PRTF
Lab Director JODANNA L. SIMON

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