37D1035876 CLIA NUMBER - ASPEN PLACE LIVING CENTER, LLC

Laboratory Demographics

CLIA Number: 37D1035876

Facility Name: ASPEN PLACE LIVING CENTER, LLC

Facility Address:
202 E 1ST ST
WETUMKA, OK
ZIP 74883
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Facility Phone Number: 405 452-3205

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1104908342

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	37D1035876
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	ASPEN PLACE LIVING CENTER, LLC
Street	202 E 1ST ST
City	WETUMKA
State	OK
ZIP	74883
Phone	405 452-3205
CertificateType	4
CertificateEffectiveDate	1/13/2023
CertificateExpirationDate	1/12/2025
FacilityType	Waiver

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