28D2235805 CLIA NUMBER - IMMANUEL

Laboratory Demographics

  • CLIA Code: 28D2235805
  • Facility Name: IMMANUEL
  • Facility Address: 1044 N 115TH STREET, SUITE 500
    OMAHA, NE
    ZIP 68154
  • Facility Phone: 402 829-2900
  • Facility Type: Other - HLTH CARE PRVDR HOME OFFI
  • Facility Type: Waiver
  • Lab Director: DR. DEVIN FOX
  • NPI Number: 1811335839
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 28D2235805
LAB Type Other - HLTH CARE PRVDR HOME OFFI
Facility Name IMMANUEL
Street 1044 N 115TH STREET, SUITE 500
City OMAHA
State NE
ZIP 68154
Phone 402 829-2900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Other - HLTH CARE PRVDR HOME OFFI
Lab Director DR. DEVIN FOX

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