22D2202850 CLIA NUMBER - BEAVEN KELLY REST HOME

Laboratory Demographics

  • CLIA Code: 22D2202850
  • Facility Name: BEAVEN KELLY REST HOME
  • Facility Address: 25 BRIGHTSIDE DR
    HOLYOKE, MA
    ZIP 01040
  • Facility Phone: 413 532-4892
  • Facility Type: Other - INDPENDENT LIVING FACILIT
  • Facility Type: Waiver
  • Lab Director: LORI HANNAH
  • NPI Number: 1790776698
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 22D2202850
LAB Type Other - INDPENDENT LIVING FACILIT
Facility Name BEAVEN KELLY REST HOME
Street 25 BRIGHTSIDE DR
City HOLYOKE
State MA
ZIP 01040
Phone 413 532-4892
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Other - INDPENDENT LIVING FACILIT
Lab Director LORI HANNAH

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