26D2117374 CLIA NUMBER - BROOKSIDE MANOR RESIDENTIAL CARE LLC

Laboratory Demographics

CLIA Number: 26D2117374

Facility Name: BROOKSIDE MANOR RESIDENTIAL CARE LLC

Facility Address:
2434 HWY H
FARMINGTON, MO
ZIP 63640
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Facility Phone Number: 573 756-6434

Facility Type: Other - RCF

Certificate Type: Waiver

NPI Number: 1902008766

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	26D2117374
LAB Type	Other - RCF
Facility Name	BROOKSIDE MANOR RESIDENTIAL CARE LLC
Street	2434 HWY H
City	FARMINGTON
State	MO
ZIP	63640
Phone	573 756-6434
CertificateType	4
CertificateEffectiveDate	8/16/2022
CertificateExpirationDate	8/15/2024
FacilityType	Waiver

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