Healther Providers Data Logo

37D0964332 CLIA NUMBER - COUNTRYSIDE ESTATES

Laboratory Demographics

CLIA Number: 37D0964332

Facility Name: COUNTRYSIDE ESTATES

Facility Address:
750 3 HWY 64
WARNER, OK
ZIP 74469
Get Directions

Facility Phone Number: 918 463-5143

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1336252089

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name Field Value
CLIA Number 37D0964332
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name COUNTRYSIDE ESTATES
Street 750 3 HWY 64
City WARNER
State OK
ZIP 74469
Phone 918 463-5143
CertificateType 4
CertificateEffectiveDate 8/23/2023
CertificateExpirationDate 8/22/2025
FacilityType Waiver

Download Record

Download this CLIA NUMBER record in Text format: Export

Download this CLIA NUMBER record in Excel (CSV) format: Export

Download this CLIA NUMBER record in XML format: Export

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