45D2195152 CLIA NUMBER - BRECKENRIDGE VILLAGE OF TYLER

Home > CLIA Lookup > 45D2195152

Laboratory Demographics

CLIA Number: 45D2195152

Facility Name: BRECKENRIDGE VILLAGE OF TYLER

Facility Address:
15062 COUNTY ROAD 1145
TYLER, TX
ZIP 75704
Get Directions

Facility Phone Number: 903 531-2151

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1770969768

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	45D2195152
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BRECKENRIDGE VILLAGE OF TYLER
Street	15062 COUNTY ROAD 1145
City	TYLER
State	TX
ZIP	75704
Phone	903 531-2151
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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