36D0680192 CLIA NUMBER - TAEJ RESIDENTIAL CARE LLC DBA DIAMONDVIEW

Laboratory Demographics

CLIA Number: 36D0680192

Facility Name: TAEJ RESIDENTIAL CARE LLC DBA DIAMONDVIEW

Facility Address:
111 S DIAMOND STREET
MANSFIELD, OH
ZIP 44902
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Facility Phone Number: 419 522-4450

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1679756837

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	36D0680192
LAB Type	Other
Facility Name	TAEJ RESIDENTIAL CARE LLC DBA DIAMONDVIEW
Street	111 S DIAMOND STREET
City	MANSFIELD
State	OH
ZIP	44902
Phone	419 522-4450
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