49D2195790 CLIA NUMBER - COMMONWEALTH SENIOR LIVING AT CHURCHLAND HOUSE

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Laboratory Demographics

CLIA Number: 49D2195790

Facility Name: COMMONWEALTH SENIOR LIVING AT CHURCHLAND HOUSE

Facility Address:
4916 W NORFOLK RD
PORTSMOUTH, VA
ZIP 23703
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Facility Phone Number: 757 483-1780

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1003382789

Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	49D2195790
LAB Type	Assisted Living Facility
Facility Name	COMMONWEALTH SENIOR LIVING AT CHURCHLAND HOUSE
Street	4916 W NORFOLK RD
City	PORTSMOUTH
State	VA
ZIP	23703
Phone	757 483-1780
CertificateType	4
CertificateEffectiveDate	10/13/2022
CertificateExpirationDate	10/12/2024
FacilityType	Waiver

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