45D2111709 CLIA NUMBER - MCANELLY LIVING CENTER

Laboratory Demographics

CLIA Number: 45D2111709

Facility Name: MCANELLY LIVING CENTER

Facility Address:
5125 MCANELLY STREET
BEAUMONT, TX
ZIP 77708
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Facility Phone Number: 409 832-4112

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1609980523

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 45D2111709
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name MCANELLY LIVING CENTER
Street 5125 MCANELLY STREET
City BEAUMONT
State TX
ZIP 77708
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