26D1083544 CLIA NUMBER - PINE VALLEY RESIDENTIAL CARE FACILITY INC

Laboratory Demographics

CLIA Code: 26D1083544
Facility Name: PINE VALLEY RESIDENTIAL CARE FACILITY INC
Facility Address: 3381 FIRST STREET
DOE RUN, MO
ZIP 63637
Facility Phone: 573 760-8601
Facility Type: Other
Facility Type: Waiver
Lab Director: SCHERYL A. FOURNIER
NPI Number: 1922526417
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	26D1083544
LAB Type	Other
Facility Name	PINE VALLEY RESIDENTIAL CARE FACILITY INC
Street	3381 FIRST STREET
City	DOE RUN
State	MO
ZIP	63637
Phone	573 760-8601
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/11/2025
Certificate Expiration Date	9/10/2027
Facility Type	Other
Lab Director	SCHERYL A. FOURNIER

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