34D2019473 CLIA NUMBER - RICH SQUARE VILLA

Laboratory Demographics

  • CLIA Code: 34D2019473
  • Facility Name: RICH SQUARE VILLA
  • Facility Address: 310 NORTH MAIN STREET
    RICH SQUARE, NC
    ZIP 27869
  • Facility Phone: 252 539-2011
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DEANNA LANIER
  • NPI Number: 1316184922
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2019473
LAB Type Assisted Living Facility
Facility Name RICH SQUARE VILLA
Street 310 NORTH MAIN STREET
City RICH SQUARE
State NC
ZIP 27869
Phone 252 539-2011
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Assisted Living Facility
Lab Director DEANNA LANIER

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