49D2012551 CLIA NUMBER - MERRYFIELD RESIDENCE

Laboratory Demographics

CLIA Code: 49D2012551
Facility Name: MERRYFIELD RESIDENCE
Facility Address: 111 HORSE MOUNTAIN VIEW
COVINGTON, VA
ZIP 24426
Facility Phone: 540 962-7732
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: ANGELA S. GOODBAR
NPI Number: 1144551144
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	49D2012551
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MERRYFIELD RESIDENCE
Street	111 HORSE MOUNTAIN VIEW
City	COVINGTON
State	VA
ZIP	24426
Phone	540 962-7732
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/7/2024
Certificate Expiration Date	9/6/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ANGELA S. GOODBAR

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This page was last updated on: 6/4/2025