49D2209372 CLIA NUMBER - WALL RESIDENCES INC

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Laboratory Demographics

CLIA Number: 49D2209372

Facility Name: WALL RESIDENCES INC

Facility Address:
159 DILLARD ROAD
MADISON HEIGHTS, VA
ZIP 24572
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Facility Phone Number: 540 745-4216

Facility Type: Other - DD WAIVER RESIDENTIALS

Certificate Type: Waiver

NPI Number: 1063436723

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	49D2209372
LAB Type	Other - DD WAIVER RESIDENTIALS
Facility Name	WALL RESIDENCES INC
Street	159 DILLARD ROAD
City	MADISON HEIGHTS
State	VA
ZIP	24572
Phone	540 745-4216
CertificateType	4
CertificateEffectiveDate	1/13/2023
CertificateExpirationDate	1/12/2025
FacilityType	Waiver

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