18D0691213 CLIA NUMBER - OUTWOOD ICF ID

Laboratory Demographics

CLIA Number: 18D0691213

Facility Name: OUTWOOD ICF ID

Facility Address:
23524 DAWSON SPRINGS ROAD
DAWSON SPRINGS, KY
ZIP 42408
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Facility Phone Number: 502 797-3771

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1194862599

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	18D0691213
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	OUTWOOD ICF ID
Street	23524 DAWSON SPRINGS ROAD
City	DAWSON SPRINGS
State	KY
ZIP	42408
Phone	502 797-3771
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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