26D1086799 CLIA NUMBER - COUNTRY AIRE ESTATES

Laboratory Demographics

CLIA Number: 26D1086799

Facility Name: COUNTRY AIRE ESTATES

Facility Address:
49303 RENSSELAER LN
HANNIBAL, MO
ZIP 63401
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Facility Phone Number: 573 221-5400

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1326113077

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	26D1086799
LAB Type	Other
Facility Name	COUNTRY AIRE ESTATES
Street	49303 RENSSELAER LN
City	HANNIBAL
State	MO
ZIP	63401
Phone	573 221-5400
CertificateType	4
CertificateEffectiveDate	7/18/2022
CertificateExpirationDate	7/17/2024
FacilityType	Waiver

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