26D2117368 CLIA NUMBER - DIANA'S BOARDING HOME #2

Laboratory Demographics

CLIA Code: 26D2117368
Facility Name: DIANA'S BOARDING HOME #2
Facility Address: 25140 BUZZARD DR
MARBLE HILL, MO
ZIP 63764
Facility Phone: 573 238-3344
Facility Type: Assisted Living Facility
Facility Type: Waiver
Lab Director: ASHLEY C. WAGNER
NPI Number: 1306438825
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	26D2117368
LAB Type	Assisted Living Facility
Facility Name	DIANA'S BOARDING HOME #2
Street	25140 BUZZARD DR
City	MARBLE HILL
State	MO
ZIP	63764
Phone	573 238-3344
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/16/2024
Certificate Expiration Date	8/15/2026
Facility Type	Assisted Living Facility
Lab Director	ASHLEY C. WAGNER

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