34D0708800 CLIA NUMBER - J IVERSON RIDDLE DEVELOPMENTAL CENTER

Laboratory Demographics

CLIA Number: 34D0708800

Facility Name: J IVERSON RIDDLE DEVELOPMENTAL CENTER

Facility Address:
300 ENOLA ROAD
MORGANTON, NC
ZIP 28655
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Facility Phone Number: 828 608-6375

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1033271002

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	34D0708800
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	J IVERSON RIDDLE DEVELOPMENTAL CENTER
Street	300 ENOLA ROAD
City	MORGANTON
State	NC
ZIP	28655
Phone	828 608-6375
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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