26D2146882 CLIA NUMBER - PARKSIDE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 26D2146882
  • Facility Name: PARKSIDE ASSISTED LIVING
  • Facility Address: 2100 PARKSIDE AVE
    ROLLA, MO
    ZIP 65401
  • Facility Phone: 573 308-0834
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: LYDIA K. COULLIETTE
  • NPI Number: 1972559276
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 26D2146882
LAB Type Assisted Living Facility
Facility Name PARKSIDE ASSISTED LIVING
Street 2100 PARKSIDE AVE
City ROLLA
State MO
ZIP 65401
Phone 573 308-0834
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2024
Certificate Expiration Date 4/8/2026
Facility Type Assisted Living Facility
Lab Director LYDIA K. COULLIETTE

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