18D2196784 CLIA NUMBER - HOPKINSVILLE OUTPATIENT VA CLINIC

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Laboratory Demographics

CLIA Number: 18D2196784

Facility Name: HOPKINSVILLE OUTPATIENT VA CLINIC

Facility Address:
4000 FORT CAMPBELL BLVD SUITE G4
HOPKINSVILLE, KY
ZIP 42240
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Facility Phone Number: 270 885-2106

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1013955954

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	18D2196784
LAB Type	Assisted Living Facility
Facility Name	HOPKINSVILLE OUTPATIENT VA CLINIC
Street	4000 FORT CAMPBELL BLVD SUITE G4
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 885-2106
CertificateType	4
CertificateEffectiveDate	10/20/2022
CertificateExpirationDate	10/19/2024
FacilityType	Waiver

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