20D0877494 CLIA NUMBER - RUSSELL PARK REHAB AND LIVING CENTER

Laboratory Demographics

  • CLIA Code: 20D0877494
  • Facility Name: RUSSELL PARK REHAB AND LIVING CENTER
  • Facility Address: 158 RUSSELL STREET
    LEWISTON, ME
    ZIP 04240
  • Facility Phone: 207 786-0691
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KRISTEN MITCHELL MD
  • NPI Number: 1962562272
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 20D0877494
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name RUSSELL PARK REHAB AND LIVING CENTER
Street 158 RUSSELL STREET
City LEWISTON
State ME
ZIP 04240
Phone 207 786-0691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2025
Certificate Expiration Date 10/3/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director KRISTEN MITCHELL MD

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