36D0680192 CLIA NUMBER - TAEJ RESIDENTIAL CARE LLC DBA DIAMONDVIEW

Laboratory Demographics

  • CLIA Code: 36D0680192
  • Facility Name: TAEJ RESIDENTIAL CARE LLC DBA DIAMONDVIEW
  • Facility Address: 111 S DIAMOND STREET
    MANSFIELD, OH
    ZIP 44902
  • Facility Phone: 419 522-4450
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: MICHAEL F. JEDRA
  • NPI Number: 1679756837
  • Taxonomy: 310400000X - Assisted Living Facility

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Other
Lab Director MICHAEL F. JEDRA

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