26D2053530 CLIA NUMBER - VICTORIAN PLACE OF HERMANN

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Laboratory Demographics

CLIA Number: 26D2053530

Facility Name: VICTORIAN PLACE OF HERMANN

Facility Address:
2120 VILLAGE LANE
HERMANN, MO
ZIP 65041
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Facility Phone Number: 573 486-5060

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1942546627

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	26D2053530
LAB Type	Assisted Living Facility
Facility Name	VICTORIAN PLACE OF HERMANN
Street	2120 VILLAGE LANE
City	HERMANN
State	MO
ZIP	65041
Phone	573 486-5060
CertificateType	4
CertificateEffectiveDate	2/1/2023
CertificateExpirationDate	1/31/2025
FacilityType	Waiver

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