28D2075119 CLIA NUMBER - COUNTRY HOUSE OMAHA, LLC

Laboratory Demographics

  • CLIA Code: 28D2075119
  • Facility Name: COUNTRY HOUSE OMAHA, LLC
  • Facility Address: 5030 SOUTH 155TH STREET
    OMAHA, NE
    ZIP 68137
  • Facility Phone: 402 964-2060
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MS. STELLA RAU
  • NPI Number: 1093116998
  • Taxonomy: 311500000X - Alzheimer Center (Dementia Center)

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CLIA Record

Field Name Field Value
CLIA Number 28D2075119
LAB Type Assisted Living Facility
Facility Name COUNTRY HOUSE OMAHA, LLC
Street 5030 SOUTH 155TH STREET
City OMAHA
State NE
ZIP 68137
Phone 402 964-2060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Assisted Living Facility
Lab Director MS. STELLA RAU

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