26D0924309 CLIA NUMBER - MAPLE RIDGE RESIDENTIAL CARE CENTER LLC

Laboratory Demographics

CLIA Number: 26D0924309

Facility Name: MAPLE RIDGE RESIDENTIAL CARE CENTER LLC

Facility Address:
1034 DORIS DRIVE
FARMINGTON, MO
ZIP 63640
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Facility Phone Number: 573 760-0155

Facility Type: Other - RESIDENTIAL CARE FACILITY

Certificate Type: Waiver

NPI Number: 1992822639

Taxonomy: 3104A0625X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.

CLIA Record

Field Name	Field Value
CLIA Number	26D0924309
LAB Type	Other - RESIDENTIAL CARE FACILITY
Facility Name	MAPLE RIDGE RESIDENTIAL CARE CENTER LLC
Street	1034 DORIS DRIVE
City	FARMINGTON
State	MO
ZIP	63640
Phone	573 760-0155
CertificateType	4
CertificateEffectiveDate	1/27/2023
CertificateExpirationDate	1/26/2025
FacilityType	Waiver

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