37D1074783 CLIA NUMBER - SANTA FE CHEYENNE HOUSE ICF-MR 16 BED

Laboratory Demographics

  • CLIA Code: 37D1074783
  • Facility Name: SANTA FE CHEYENNE HOUSE ICF-MR 16 BED
  • Facility Address: 1000 S SANTA FE AVE, BLDG B
    MOORE, OK
    ZIP 73160
  • Facility Phone: 405 793-1643
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: JASON N. MADDEN
  • NPI Number: 1134302573
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 37D1074783
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name SANTA FE CHEYENNE HOUSE ICF-MR 16 BED
Street 1000 S SANTA FE AVE, BLDG B
City MOORE
State OK
ZIP 73160
Phone 405 793-1643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2025
Certificate Expiration Date 10/4/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director JASON N. MADDEN

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