38D2179837 CLIA NUMBER - RUSSELLVILLE PARK

Laboratory Demographics

  • CLIA Code: 38D2179837
  • Facility Name: RUSSELLVILLE PARK
  • Facility Address: 20 SE 103RD AVENUE
    PORTLAND, OR
    ZIP 97216
  • Facility Phone: 503 254-5900
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SARA ALBERS
  • NPI Number: 1164845921
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 38D2179837
LAB Type Assisted Living Facility
Facility Name RUSSELLVILLE PARK
Street 20 SE 103RD AVENUE
City PORTLAND
State OR
ZIP 97216
Phone 503 254-5900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Assisted Living Facility
Lab Director SARA ALBERS

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