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29D0538187 CLIA NUMBER - INTERMOUNTAIN HEALTHCARE - S DECATUR

Laboratory Demographics

CLIA Number: 29D0538187

Facility Name: INTERMOUNTAIN HEALTHCARE - S DECATUR

Facility Address:
4500 W OAKEY BLVD
LAS VEGAS, NV
ZIP 89102
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Facility Phone Number: 702 873-5110

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1447344353

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 29D0538187
LAB Type Physician Office
Facility Name INTERMOUNTAIN HEALTHCARE - S DECATUR
Street 4500 W OAKEY BLVD
City LAS VEGAS
State NV
ZIP 89102
Phone 702 873-5110
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024