28D2016544 CLIA NUMBER - MOSAIC - FAIDLEY

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Field Name	Field Value
CLIA Number	28D2016544
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MOSAIC - FAIDLEY
Street	MOSAIC-ICF/ID 2915 W FAIDLEY
City	GRAND ISLAND
State	NE
ZIP	68803
Phone	308 381-0137
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	11/19/2024
Certificate Expiration Date	11/18/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ALICIA R. FURREY

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