37D2003283 CLIA NUMBER - COUNTRY LANE - COTTAGE 1

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Laboratory Demographics

CLIA Number: 37D2003283

Facility Name: COUNTRY LANE - COTTAGE 1

Facility Address:
303 E 7TH STREET
BEGGS, OK
ZIP 74421
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Facility Phone Number: 918 267-3362

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1376075051

Taxonomy: 311ZA0620X - Custodial Care Facility
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

CLIA Record

Field Name	Field Value
CLIA Number	37D2003283
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	COUNTRY LANE - COTTAGE 1
Street	303 E 7TH STREET
City	BEGGS
State	OK
ZIP	74421
Phone	918 267-3362
CertificateType	4
CertificateEffectiveDate	2/4/2024
CertificateExpirationDate	2/3/2026
FacilityType	Waiver

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