37D2218921 CLIA NUMBER - PADDINGTON PLACE COTTAGE A PADDINGTON PLACE, LLC

Laboratory Demographics

CLIA Number: 37D2218921

Facility Name: PADDINGTON PLACE COTTAGE A PADDINGTON PLACE, LLC

Facility Address:
76 W RACHEL ST, UNIT A
BIXBY, OK
ZIP 74008
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Facility Phone Number: 405 285-8166

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1043834849

Taxonomy: 310500000X - Intermediate Care Facility, Mental Illness
A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	37D2218921
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PADDINGTON PLACE COTTAGE A PADDINGTON PLACE, LLC
Street	76 W RACHEL ST, UNIT A
City	BIXBY
State	OK
ZIP	74008
Phone	405 285-8166
CertificateType	4
CertificateEffectiveDate	3/31/2023
CertificateExpirationDate	3/30/2025
FacilityType	Waiver

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