38D2118594 CLIA NUMBER - WALLOWA RIVER HOUSE

Laboratory Demographics

CLIA Code: 38D2118594
Facility Name: WALLOWA RIVER HOUSE
Facility Address: 601 WHISKEY CREEK ROAD
WALLOWA, OR
ZIP 97885
Facility Phone: 541 886-3142
Facility Type: Other - RESIDENTIAL TRTMNT
Facility Type: Waiver
Lab Director: BRIDGET C BROWN
NPI Number: 1417192972
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	38D2118594
LAB Type	Other - RESIDENTIAL TRTMNT
Facility Name	WALLOWA RIVER HOUSE
Street	601 WHISKEY CREEK ROAD
City	WALLOWA
State	OR
ZIP	97885
Phone	541 886-3142
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/12/2024
Certificate Expiration Date	9/11/2026
Facility Type	Other - RESIDENTIAL TRTMNT
Lab Director	BRIDGET C BROWN

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