26D0970221 CLIA NUMBER - COUNTRYSIDE HOME

Laboratory Demographics

  • CLIA Code: 26D0970221
  • Facility Name: COUNTRYSIDE HOME
  • Facility Address: 24499 PARK DRIVE
    LEBANON, MO
    ZIP 65536
  • Facility Phone: 417 532-7418
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: VELMA J. MAYDEW
  • NPI Number: 1043520133
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 26D0970221
LAB Type Other
Facility Name COUNTRYSIDE HOME
Street 24499 PARK DRIVE
City LEBANON
State MO
ZIP 65536
Phone 417 532-7418
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Other
Lab Director VELMA J. MAYDEW

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