46D0525403 CLIA NUMBER - MEDALLION MANOR NURSING

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Field Name	Field Value
CLIA Number	46D0525403
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MEDALLION MANOR NURSING
Street	1701 W 600 S
City	PROVO
State	UT
ZIP	84601
Phone	801 375-2710
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/1/2024
Certificate Expiration Date	8/31/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	HEATHER FRAUGHTON

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