26D0716476 CLIA NUMBER - LIFE CARE CENTER OF SULLIVAN

Laboratory Demographics

  • CLIA Code: 26D0716476
  • Facility Name: LIFE CARE CENTER OF SULLIVAN
  • Facility Address: 875 DUNSFORD DRIVE
    SULLIVAN, MO
    ZIP 63080
  • Facility Phone: 573 468-3128
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MATTHEW TAYLOR
  • NPI Number: 1568419232
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 26D0716476
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LIFE CARE CENTER OF SULLIVAN
Street 875 DUNSFORD DRIVE
City SULLIVAN
State MO
ZIP 63080
Phone 573 468-3128
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MATTHEW TAYLOR

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