41D2248725 CLIA NUMBER - LIVING IN FULFILLING ENVIRONMENTS

Laboratory Demographics

  • CLIA Code: 41D2248725
  • Facility Name: LIVING IN FULFILLING ENVIRONMENTS
  • Facility Address: 490 METACOM AVENUE
    BRISTOL, RI
    ZIP 02809
  • Facility Phone: 401 396-8003
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ELIZABETH WIEDENHOFER
  • NPI Number: 1649305541
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 41D2248725
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name LIVING IN FULFILLING ENVIRONMENTS
Street 490 METACOM AVENUE
City BRISTOL
State RI
ZIP 02809
Phone 401 396-8003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2024
Certificate Expiration Date 1/14/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ELIZABETH WIEDENHOFER

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