26D0889301 CLIA NUMBER - AUTUMN RIDGE RESIDENTIAL CARE

Laboratory Demographics

  • CLIA Code: 26D0889301
  • Facility Name: AUTUMN RIDGE RESIDENTIAL CARE
  • Facility Address: 300 AUTUMN RIDGE DRIVE
    HERCULANEUM, MO
    ZIP 63048
  • Facility Phone: 636 931-8400
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SUSAN KOCH
  • NPI Number: 1780803221
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 26D0889301
LAB Type Assisted Living Facility
Facility Name AUTUMN RIDGE RESIDENTIAL CARE
Street 300 AUTUMN RIDGE DRIVE
City HERCULANEUM
State MO
ZIP 63048
Phone 636 931-8400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2024
Certificate Expiration Date 7/24/2026
Facility Type Assisted Living Facility
Lab Director SUSAN KOCH

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