45D2111703 CLIA NUMBER - JERRY LIVING CENTER

Laboratory Demographics

CLIA Number: 45D2111703

Facility Name: JERRY LIVING CENTER

Facility Address:
4415 JERRY DRIVE
BEAUMONT, TX
ZIP 77703
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Facility Phone Number: 409 832-4112

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1134233059

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	45D2111703
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	JERRY LIVING CENTER
Street	4415 JERRY DRIVE
City	BEAUMONT
State	TX
ZIP	77703
Phone	409 832-4112
CertificateType	4
CertificateEffectiveDate	4/13/2024
CertificateExpirationDate	4/12/2026
FacilityType	Waiver

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