37D1035872 CLIA NUMBER - MAPLE PLACE LIVING CENTER, LLC

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Field Name	Field Value
CLIA Number	37D1035872
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MAPLE PLACE LIVING CENTER, LLC
Street	622 S ALABAMA
City	WETUMKA
State	OK
ZIP	74883
Phone	405 452-3476
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/13/2025
Certificate Expiration Date	1/12/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	CRYSTAL S. FREEMAN

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