36D2054350 CLIA NUMBER - BROOKDALE BUCK CREEK

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Laboratory Demographics

CLIA Number: 36D2054350

Facility Name: BROOKDALE BUCK CREEK

Facility Address:
3270 MIDDLE URBANA ROAD
SPRINGFIELD, OH
ZIP 45502
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Facility Phone Number: 937 390-0432

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1598912073

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	36D2054350
LAB Type	Assisted Living Facility
Facility Name	BROOKDALE BUCK CREEK
Street	3270 MIDDLE URBANA ROAD
City	SPRINGFIELD
State	OH
ZIP	45502
Phone	937 390-0432
CertificateType	4
CertificateEffectiveDate	2/20/2023
CertificateExpirationDate	2/19/2025
FacilityType	Waiver

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