28D2017760 CLIA NUMBER - MOSAIC OMAHA MANCHESTER ICF/ID

Laboratory Demographics

CLIA Code: 28D2017760
Facility Name: MOSAIC OMAHA MANCHESTER ICF/ID
Facility Address: 2814 NORTH 169TH STREET
OMAHA, NE
ZIP 68116
Facility Phone: 402 896-9988
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: MS. DANA WINN RN BSN
NPI Number: 1467648725
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	28D2017760
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MOSAIC OMAHA MANCHESTER ICF/ID
Street	2814 NORTH 169TH STREET
City	OMAHA
State	NE
ZIP	68116
Phone	402 896-9988
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/17/2024
Certificate Expiration Date	12/16/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	MS. DANA WINN RN BSN

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