45D2203476 CLIA NUMBER - GOVERNOR'S RIDGE RETIREMENT & ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 45D2203476
  • Facility Name: GOVERNOR'S RIDGE RETIREMENT & ASSISTED LIVING
  • Facility Address: 300 E DEVEREAUX ST
    DECATUR, TX
    ZIP 76234
  • Facility Phone: 940 627-1104
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: LESLIE MISENHIMER
  • NPI Number: 1972961415
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D2203476
LAB Type Assisted Living Facility
Facility Name GOVERNOR'S RIDGE RETIREMENT & ASSISTED LIVING
Street 300 E DEVEREAUX ST
City DECATUR
State TX
ZIP 76234
Phone 940 627-1104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Assisted Living Facility
Lab Director LESLIE MISENHIMER

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