36D2212103 CLIA NUMBER - COURT HOUSE MANOR (ALF)

Laboratory Demographics

CLIA Number: 36D2212103

Facility Name: COURT HOUSE MANOR (ALF)

Facility Address:
555 N GLENN AVENUE
WASHINGTON COURT HOUSE, OH
ZIP 43160
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Facility Phone Number: 740 335-9290

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1467972075

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2212103
LAB Type	Assisted Living Facility
Facility Name	COURT HOUSE MANOR (ALF)
Street	555 N GLENN AVENUE
City	WASHINGTON COURT HOUSE
State	OH
ZIP	43160
Phone	740 335-9290
CertificateType	4
CertificateEffectiveDate	2/2/2023
CertificateExpirationDate	2/1/2025
FacilityType	Waiver

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