26D1082574 CLIA NUMBER - PINE LODGE RESIDENTIAL CARE

Laboratory Demographics

  • CLIA Code: 26D1082574
  • Facility Name: PINE LODGE RESIDENTIAL CARE
  • Facility Address: 967 N MAPLE
    BUFFALO, MO
    ZIP 65622
  • Facility Phone: 417 345-0310
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: PAULINE S. GUNTER
  • NPI Number: 1124275482
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 26D1082574
LAB Type Assisted Living Facility
Facility Name PINE LODGE RESIDENTIAL CARE
Street 967 N MAPLE
City BUFFALO
State MO
ZIP 65622
Phone 417 345-0310
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2024
Certificate Expiration Date 4/13/2026
Facility Type Assisted Living Facility
Lab Director PAULINE S. GUNTER

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