38D0625576 CLIA NUMBER - TIERRA ROSE CARE CENTER LABORATORY

Laboratory Demographics

CLIA Number: 38D0625576

Facility Name: TIERRA ROSE CARE CENTER LABORATORY

Facility Address:
4254 WEATHERS ST NE
SALEM, OR
ZIP 97301
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Facility Phone Number: 503 585-4602

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1386631422

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name	Field Value
CLIA Number	38D0625576
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	TIERRA ROSE CARE CENTER LABORATORY
Street	4254 WEATHERS ST NE
City	SALEM
State	OR
ZIP	97301
Phone	503 585-4602
CertificateType	4
CertificateEffectiveDate	5/22/2022
CertificateExpirationDate	5/21/2024
FacilityType	Waiver

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