28D0973430 CLIA NUMBER - IMMANUEL VILLAGE ASSISTED LIVING

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CLIA Code: 28D0973430
Facility Name: IMMANUEL VILLAGE ASSISTED LIVING
Facility Address: 6801 N 67TH PLAZA
OMAHA, NE
ZIP 68152
Facility Phone: 402 829-3240
Facility Type: Assisted Living Facility
Facility Type: Waiver
Lab Director: MS. MARY J. HANGMAN
NPI Number: 1811207889
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	28D0973430
LAB Type	Assisted Living Facility
Facility Name	IMMANUEL VILLAGE ASSISTED LIVING
Street	6801 N 67TH PLAZA
City	OMAHA
State	NE
ZIP	68152
Phone	402 829-3240
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	5/4/2024
Certificate Expiration Date	5/3/2026
Facility Type	Assisted Living Facility
Lab Director	MS. MARY J. HANGMAN

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