37D0656737 CLIA NUMBER - LAKE DRIVE CARE AND REHABILITATION

Laboratory Demographics

CLIA Number: 37D0656737

Facility Name: LAKE DRIVE CARE AND REHABILITATION

Facility Address:
600 LAKE ROAD
HENRYETTA, OK
ZIP 74437
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Facility Phone Number: 918 652-8101

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1598002966

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	37D0656737
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LAKE DRIVE CARE AND REHABILITATION
Street	600 LAKE ROAD
City	HENRYETTA
State	OK
ZIP	74437
Phone	918 652-8101
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